Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document Westchester gov.com ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 Time/Date Set: Sample Type (circle one): 1/Potable 3. Non Potable Treated 2. Non Potable 4. Other Time/Date Collected: LAВ 114/02 Collected By: 1AD Lang cooo newe Collected From: Location's/Individuals Name Street City/St/Zip Identification of Source Collection Point 7 13l) Bottle #'s: Chain of Custody? Comments: PWS #:2 Bill to: Name/Company Street City/St/Zip Phonett: 316 _ Yes No Source ID: CA,CH, BI? BACTERIOLOGICAL ANALYSIS Lab#: Lab# Heterotrophic Plate Count (hemodialysis & all others) Coliform PIA (Public supplies) Coliform MPN (priv well, raw, stp) Fecal Coliform (all samples) Microscopic Macroscopic API Othera Refrigerated? - yes L no Chlorinated:? - yes_ no Free Chlorine Rest -mg/L Total Chlorine Res: - mg/L рH RADIOCHEMICAL ANALYSIS Radon Other ORGANIC POTABLE ANALYSIS Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) Microextractables (504) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) Herbicides (515) Pesticides (525) Carbamate Pesticides (531) Glyphosate (547) Diquat (549) Chlorination Disinfection Byproducts (551) _ Haloacetic Acids (552) _Other Pesticides (SM18/6630) UCMR List 1 -MIBE Only (524) INORGANIC ANALYSIS REQUESTED - Lab#: Color Turbidity pH Conductivity Corrosivity (temp: °C) BOD (5 day) Carbonaceous BOD (5 day) Soluble BOD (5 day) Chemical Oxygen Demand Dissolved Oxygen Total Organic Carbon Total Organic Halides Solids, Percent (%) Solids, Settleable Solids, Suspended Solids, Total Solids, Total Dissolved Solids, Total Volatile Other: Acidity Alkalinity Bromide Bromate/Chlorate/Chlorite ehloride Cyanide Fluoride Hardness, Total as CaCO3 Nitrogen, Ammonia as N Nitrogen, Nitrate as N Nitrogen, Nitrite as N Nitrogen, Total Kjeldahl as N Oil and Grease Phenol Phosphorus Total as P Phosphorus, Ortho as P Sulfates Surfactants UV254 Aluminum Antimony Arsenic Barium Beryllium Boron Cadmium Calcium, as CaCO3 Calclum, Ca+2 Chromium, Total Chromium, Hexavalent Cobalt Copper Iron Lead Magnesium Manganese Mercury Molybdenum Nickel NYC-WTC_000072958 nelc NYS-ELAP No. 10108 Form A-70 (rev. 10/01) 0118 alype Descriptor: Fax#: Check#: Amount$ ORGANIC NONPOTABLE/SOLID ANALYSIS Purgeable Halocarbons (624/8260) Purgeable Aromatics (624/8260) Acrolein & Acrylonitrile (8260) Organochlorine Pesticides (608/8081) PCB's (Arochlors) (608/8081) Herbicides (SM18/6630,8151) Other Pesticides (SM18/6630) Petroleum Hydrocarbon Scan (310-13) Glycols in Water Acid Extractables (625/8270) Base Neutral Extractables (625/8270) X GC/MS Unknown Scan Phthalates (606MS) L Other: Potassium Selenium Silver Sodium Thallium Vanadium Zinc CLP Metals/CN Volatiles Semi-violatiles Pesticides/PCB's TCLP TCLP-Metals TCLP-Pesticides TCLP-Herbicides TCLP-Volatiles TCLP-BNA'S