Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

A ENVIRdNMENTAL/SERVICES SAMPLE SUBMISSION^FORM f5 a pit ster . iv.com WEStCHESfER’cOUNTY LABORATOR ’ Y 0'5 ■a] 2 Dana Road, Valhalla, New York'10595 - _ 7 ' V- ,F (914)593-5575- ’ NYS-ELAP No. 10108 s/Date Set: ' ’ ' (rev.1/96)

Sami (circle one): "I. Potable^ ' 3. Non Potable Treated Bottle #’s: j QF ''’2JNon Potable 4. Other Chain of Custody?yes no XTime/Date Collected: r -- S/ // / it) ■ 1 S-foZ Comments: /.Collected By: Agency Code: PWS #: J_____ Source ID: Type Descriptor: Collected From: Bill to: Location's/lndividual’s Name Name/Company street__ Street_______ City/St/Zip VAtf^-fALlA City/St/Zip Identification of Sourpe '______ __________________ Phone#: Fax#: Collection Point______ TO i-|___________________ CA.CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_______________________ Lab#: ' .(circle tests) (circle tests) 1. Heterotrophic. Plate 1,. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count, (hemodialysis & all others) 2.^olatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Y Aromatics (524) 3. Acrolein & Acrylonitrile (624) .3. 'Coliform MPN (priv well, raw, stp) 4S>Iotal Trihalomethane Potential (510) 4. Phthalates (625/8270) 4, Fecal Coliform (all samples) 5. Microextractables (504) j 5. Organochlorine Pesticides (608/8081) '<1 '5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) croscopic • (7^ Pesticides/PCB screen (508) ■'7. Methoprene(616) I 8.7PCB as Decachlorobiphenyl (508A) 8. Herbioides (EPAI 978/8151) ‘8. Other: 9. Herbicides (515) 9,' Pesticides (SM18/6630) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? yes no IT Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat’, (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551)I (^A^C/MS Semivolatile Unknown Scan Total Chlorine Res:. mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SMI8/6630) 16. Purgeable Aromatics (DEF) pH 17. Pelroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:. .. J ' 18. Other:; 22? INORGANIC ANALYSIS REQUESTED r Lab#: (circle tests) 2:^ 1., Color 20. Acidity 39*Aluminum 59. Potassium 21. Alkalinity, as CaCOs ^^ntimony 60. Selenium 2. Turbidity 3. pH 22. Bronriide 41. Arsenic 61. Silver 4. Conductivity ■ 23. Bromate/Chlorate/Chlorite 42^arium 62^Sodium 24. Chloride M3^eryllium ^S^hallium 5. Corrosivity (temp:. .®C) 6. BOD (5 day) . 25. Cyanide 44. Boron . 6^ Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium ' ' 65. Zinc 8. Carbonaceous BOD (5 day) . 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs 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 42JChfomium, Hexavalent 68. Semi-violatiles 12.^Total Organic Halides ■ ' ■ 31.' Nitrogen. Total Kjeldahl as N. (^Q-tobalt 69. Pesticides/PCB’s Solids, Percent (%) 32. Oil an,Grease< - • , 51 ..Copper • 70. Disk Deliverables z Solids, Settleable-, 33, PheQolx^ ‘ : 52. Iron TCLP \ ^^Solids, Suspended ■. 34. Phdsphorus Total as P . 53.Lead 71 TCLP-MetaJs^ . 16;.^licls, Total/ , 35.’Phosphorus.' Ortho, as'P' 54'Magnesium J2/TcLP.-PeSticides /17;. Solids. Total .Dissolvedj ■36>.Sulfated ’ ‘ 55 Manganese; 73.TCLP-Herbicides. m')S6lids),T^VVolatiiez^, • ' ‘3-7?,Surfactants • r SfijMercury? i74.’^TCLP-Volatiles^' (^ Other:: .Sn j-rfT.ft. „ . ( I JS^-TCU^BNA’S} ■' Y ■ ' Y 38^Nickeli .

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