Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document V-'-

H ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla. New York 10595 (914) 593-5575 NYS-ELAP No. 10108 ^^e/Date Set:_________ Form A-70 (rev. 1/96) Sample Type (circle one); 4^ w V ' n’Wo ■ z, Q) Potable 3. Non-Potable Treated Bottle #’s: f 2. Non-Potable 4. Other____________ Chain of Custody?yes no Time/Date Collected:. Comments: Collected Bv: "S'. R tK A KC!i>O .Agency Code: PWS #;_______ Source ID: Type Descriptor:. Collected From: Bill to; Location's/lndividual’s Name "feRoSV Name/Company Street______________ Street________ City/SVZip__________ City/SVZip Identification of Source. Phone#: _______ Fax #: Collection Point 1 CA. CH Bl? Check#; Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#;______________________ Lab #;____________________________ (circle tests) (drcle tests) 1. Heterotrophic Plate L Trihalomefhanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) / Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) ' <3f Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4.' Total Trihalomethane Potential (510) 4. Phthalates (606/8060) j.. . 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) . 5. Microscopic Pesticides (507) 6. PCB’s (Arochlors) (608/8080) Macroscopic ■ Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) . 8. PCB as Decachlorobiphenyl (508A) | 8. Other Pesticides (SM-18/6630) brother;_________ ;__________ Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13^ Pesticides (525) 10. Glycols in Water Refrigerated? yes no 11. Carbamate Pesticides (531) J 11. Acid Extractables (625/8270) 12. Glyphosate (547) ■ 12. Base Neutral Extractables (625/8270) . 7 Chlorinated?: .yes no 13. Diquat (549) GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) Purgeable Halocarbons (DEF) “ c: Free Chlorine Res;. .mg/L, 15. Haloacetic Acids (552)’ 15. Purgeable Aromatics (DEF) K i ' 16. Pesticides (DEF) J' 16. Other Pesticides (SM-,18/6630) ' . -i: Total Chlorine Re’s: .mg/L . 17.-Petroleum/Hydrocarbon Scan (31045) 17. PCB’s (Arochlors) (DEF) r pH- _____ 1 V A t T-

INORGANIC ANALYSES REQUESTED,Lab#: (circle tests) 1. Color 2O.''Acidity 39. Aiutpin^m 59. Potassium i 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimoiiy 60. Selenii^ 3. pH 22. Bromide 41. Arseni^Vi 61. Silver j' 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Bariun^-'' 62. Sodiurn 5. Corrosivity (temp: .“C) 24. Chloride 43. Berylliifhi 63. Thallium 6. BOD (5 day) 7. Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 25. Cyanide. 26. Fluoride 27. Hardness. Total as CaCOa 44. Boron 45. Cadmium 46. Calcium, as CaCOa 64. Vanadium 65. Zinc ________ CLP c 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 |3. Solids, Percent (%) * ■ 32. Oil and Grease 51. Copper 70. Disk Deliverables *4. Solids. Settleable 33. Phenol 52. Iron ISLE 15. Solids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. Solids, Total , 35. Phosphorus, Ortho as P ^!i^4. 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. UV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel

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