Chain of custody form, Westchester County Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

HL ^^e/Date Set:_________________________ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla. New York 10595 (914)593-5575 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Sample Type (circle one); f-' 4, : ’ Y. 7.772. 1. Potable 3. Non-Potable Treated Bottle #’s:_£72^LJW2_E2E<iJ^EZL^^ 2. Non-Potable 4. Other - / Chain of Custody? .yes no Time/Date Collected: _____ Comments: Collected By:, AoencvCode: PWS #:_____________ Source ID; ^Type Descriptor;. Collected From; x Bill to. Location's/lndividual's Name L.) Name/Company Street Street________ __ City/St/Zip. City/St/Zip___________ Identification "of Source Phone#:, ' ._Fax #:_ Y Col lection Point? : ' ?C I CA. CH, - Check#:, <" Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES *W?;$^RGANIC NONPOTABLE/SOLID ANALYSES Lab#: (circle tests) ■ . r: 1. Heterotrophic Plate ___________

Count (hemodialysis & all others) '■ 1. Trihalomethanes (524) ■ Volatile Halocarbons (524) ■ sssasw ./- Purgeable Halc^arbons'(62^260);YY/ 'V^J2Y'’Purgeable Arornatics (624/8^bt/i%^t;'? 2. Coliform P/A (ppblic supplies) ka/ Volatile Aromatics (524) Acrolein & Acryl6nitrile'(624t=^^ET, 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (51 of’3 .' 4?' Phthalates (606/8060) ' 'AE-r'E* 4. Fecal Coliform (all samples) 5. Microextractables (504) k ■' 5. Organochlorine Pesticides (60^8080)3 5. Microscopic 6^ Pesticides (507) 3.. ''6. PCB’s (Arochlors) ' ...........(608/8080) ■■ " 6. Macroscopic /7J Pesticides/PCB screen (508) .7. Herbicides (SM-1 8/6640; 8151) o 's. PCB as Decachlorobiphenyl (508A)'k3 ’ 8. Other Pesticides (SM-1 ^6630) ___________ 9 Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) u (to) Pesticides (525) 10. Glycols in WateZ Refrigerated? .yes. no Tf. Carbamate Pesticides (531) r' ii 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12 Base Neutral Extractables (625/8270) Chlorinated?; .yes. .no 13. Diquat (549) i, ■ ^^GC/MS Unknown Scan . 14. Chlorination Disinfection Byproducts (551)' 1< 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 (310^3) ’ 17. PCB’s (Arochlors) (DEF)

£H io INORGANIC ANALYSES REQUESTED - Lab#;. (circle tests) i' • ' 1. Color 20. Acidity 39. Aluminum 59. Potassium /"/; j’-'L' CD 2. T urbidity 21. Alkalinity, as CaCOa 40. Antimony/ 60. Selenium ? .“j-; 3. pH 22. Bromide 41. Arsenict’ '" 61. Silver ■ 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Bariurrt': 62. Sodium ; 5. Corrosivity (temp: “C) 24. Chloride 43. Beryllium 63. thallium ; 6. BOD (5 day) ’ 25. Cyanide . 44. Boron 64. Vanadium' 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc ____________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calciam. 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 Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables______ Solids. Settleable 33. Phenol 52. Iron ICLP 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-Horbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_____________ 38. I.IV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel . t

NYC-WTC_000072445