Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

lU ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 J^Bttehester County NYS-ELAP No. 10108 (914) 593-5575 H^ie/Dale Set:_________ Form A-70 (rev. 1/96) Sample Type (circle one): (l^ Potable Bottle #’s:C. c 47*^ (f j , '7 3. Non-Potable Treated 2. Non-Potable 4. Other_____________ Chain of Custody? yes no Time/Date Collected;. V, toh4|2.6o| Comments: Collected Bv: "X'. A AbO Agency Code: PWS #;_________ Source ID: Type Descriptor:, Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street_____________________________ Street__________ City/SVZip________________________ City/St/Zip Identification of Source,.^______________ Phone#:_ Fax #;_____________ Collection Point, P-X 5^ I CA. CH. Bl?. Check#:, Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ Lab #;_________ ___________________ (circle tests) (circle tests) 1. Heterotrophic Plate 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) 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 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic (2/ Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. PCB as Decachlorobiphenyl (508A), ■ 8. Other Pesticides (SM-18/6630) ^^Other: 9*. Herbicides (515) .r. 9. Petroleum Hydrocarbon Scan (310-13] Pesticides (525) Y 10. Glycols in Water' Refrigerated? .yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12^Base Neutral Extractables (625/8270) ... Chlorinated?; .yes. .no 13. Diquat (549) X^GC/MS Unknown Scan > , 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. I ~. mo/L •• 15. Haloacetic Acids (552) , ' 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) ... 16. Pesticides (DEF) Total Chlorine Res: 2 mg/L 17. Petroleum/Hydrocarbon Scan (310-^^)? 17. PCB’s (Arochlors) (DEF) c X. pH •» V « , . ... . INORGANIC ANALYSES REQUESTED - Lab#; (circle tests) 1. Color ' 20. Acidity 39. Aluminum 59. Potassium j 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimoi^y . 60. Selenium ; 3. pH 22. Bromide 41. Arseni^' ■ ■- 61. Silver 4. Conductivity 23, Bromate/Chlorate/Chlorite 42. Bariuni^!?* 62. Sodium 5. Corrosivity (temp: 6. BOD (5 day) .’C) 24. Chloride 25.^ Cyanide 43. BerylliOm 44. Boron 63. Thallium 4 64. Vanadium ’ c 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness. Total as CaCOa 46. Calcium, as CaCOa 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 , 1^. Solids, Percent (%) 32, Oil and Grease 51. Copper 70. Disk Deliverables Solids. 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. IIV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel

NYC-WTC_000072251