Chain of custody form, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

.tf<nsT^ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM jester WESTCHESTER COUNTY LABORATORIES AND RESEARCH rov.com 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Titrate Set: V Form A-70 (rev.1/96)

Sample Type (circle one): o if £>..??</. .7’ar.z. 93^/ 1. Potable 3. Non Potable Treated Bottle # s:_____________________________ _________________ 2. Non Potable 4. Other Chain of Custody?___ yes no Time/Date Collected: Comments: Collected By: r. Tj/z/ Agency Code: PWS #:_________ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street_______________ 1_________ Street__________ City/St/Zip '________________ City/St/Zip Identification of Source ' * Phone#: Fax#:'. ’> tu. Collection Point _ <CA,CH, BI?M^ Check#: .... '' ■ ■ (fc: .asM-s« • .■ A'

BACTERIOLOGICAL ANALYSES . ’ ORGANIC POTABLE ANALYSIS '^^ORGANlObNPO^BLEOgX^ Lab#: Lab#: / |' (circle teste) iV'- '' (circle teste) 1. Heterotrophic Plate 1. Trihalomethanes (5?4) ' ' 1. Purgeable Halocarbons /(624/826b) - .--; ? , Count (hemodialysis & all others) /2?\Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) ’ 2. Coliform P/A (public supplies) Xgy^Volatile Aromatics (524) 3. Acrolein & Acrylonitrile'(62T) :‘jY r* 3. Coliform MPN (privwell, raw,stp) 4.^'Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) '5.; Microextractables (504) 5. Organochlorine Pesticides: (60'8/808l’) 5. Microscopic '■^ Pesticides (507) 6. PCB’s (Arochlors) (608/8081) '' ' 6. M|woscopic C^} Pesticides/PCB screen (508) 7. Methoprene (616) ■<i 8.’ PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI 978/8151) , 8. Owr:_______________ _ 9, Herbicides (515) 9. Pesticides (SMI 8/6630) @ Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) . Refrigerated?yes no 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) 14.'GC/MS Semivolatile Unknown Scan 15. Haloacetic Acids (552) ^5. Purgeable Halocarbons (DEF) Total Chlorine Res: mg/L 16. Pesticides (SMI8/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:,_________________________ .18. Other:___________ __2_____________

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) ------ ■' I VAI ( 39. Alumij^^m V V-'*'/ t' Y 1. Color 20. Acidity 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium ; 3. pH 22. Bromide 41. Arsenic 61. Silver j 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 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 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 49. Chromium, Hexavalent 68. Semi-violatiles 12.-Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s .13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables l^^ids. Settleable 33. Phenol 52. Iron I^Hids, Suspended 34. Phosphorus Total as P 53.Lead ICLP 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-Vola'tiles 19. Other:________ ._________ 38. UV254 57 Molybdenum 75.TCLP-BNA’S ' 58. Nickel

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