Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 Hl NYS-ELAP No. 10108 jJ^/DateSeL______ Form A-70 (rev. 1/96) Sample Type (circle one): 1. Potable ■ 3. Non-Potable Treated Bottle #'s:_________ 2. Non-Potable 4. Other_______________________ _________ Chain of Custody? .yes no Time/Date Collected: i 0 \ Comment8:^ Collected Bv: ■- -Je /- 'i'> > :u >Aqencv Code: PWS #:___________ Source IO: .Type Descriptor:. Collected From’:,? Bill to: Location’s/lndividual's Name_ - • _________ Name/Company Street________ ■ ~- • ■ _______________________________ Street_____________ Citv/St/ZiD ' ________________________________ City/St/Zip Identification of Source '_______________________________ Phone#:_ .Fax Collection Point .■ / r'O O____________________ [cATcHTBi?^^ Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANrC POTABLE ANALYSER ORGANIC NONPOTABLE/SOLID ANALYSES 'Lab#i \ / / z? fdrcietests) (circle lest^ V/ 1. Heterotrophic Plqte ■ ; \ 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) ' • ■ Count (hemodialysis. & all others) - ' Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) ' <3/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv/well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) : 4. Fecal Coliform (all samples). 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic' Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic?-: ' ' ' ' 8. Pesticide^PCB screen (508) PCB as Decachlorobiphenyl (508A) 7. Herbicides (SM-18/6640; 8151) 8. Other Pesticides (SM-18/6630) «J Q f Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) I. Pesticides (525) 10. Glycols in Water Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Extractabies (625/8270) 12. Glyphosate (547) 12- Base Neutral Extractabies (625/8270) Chlorinated^:. -• • yes ^^GC/MS Unknown Scan no 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res; mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) >' pH f/* A

INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium ■ 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium 1 / 3. pH .22. Bromide 41. Arsenic 61. Silver ' I 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: .’C) 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium j 7. Soluble BOD (5 day) • 26. Fluoride 45. Cadmium 65. Zinc______ i 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca‘’ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N. 48. Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB's ^^olids. Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables ^Bolids. Settleable 33. Phenol 52. Iron TCLP 15’'Solids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. Solids. Total 35. Phosphorus. Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_______________ 38. I.IV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel

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