Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM •Sier aa-qiit WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 s * 2 NYS-ELAP No. 10108 Time/Date Set: z a J.. ;... Form A-70 (rev. 10/01) B.E S V Sam:ipie Type (circle one): r- 2.795 p I 'otabie 3. Non Potable Treated Bow* its; z- I kfeS/a Ae Zrprg.fit Chain of Custody?Yes No E /.Z.X i■ 2. Non Potable 4. Other___________ _ 1 ■ Time/Date Collected:________________ Zq "B c Commutits: Collected By: .Z_ Vz'OzOz (___ Agency Code:: PWS #:____ __ Source ID;Type Descriptor: COIpctcd Front: Bill to; Location’s/lndividual’s Name N ; I___ • L-," Z_______ Name/Company ■I ■ Street ___ V'O । - E ( j ■ - U ___tE..L_.;_kLC______ _ IHlIliBI City/St/Zip B - L- ; i -K) - ,; . SB E City/St/Zip _ Identification of Source________________________ _ Phone#: . Fax#: „.J Collection Point _ Og 1 I : CA.CH, Bi?^ Check#:: Amount$,„

BACTERIOLOGICAL ANALYSIS Lab#:: Bill lillBllIBIIIIIIill Lab#:______________________ _ a."-'-"/'/' I __ Heterotrophic Plate Count ORGANIC POTABLE ANALYSIS __ Trihalomethanes (524) ORGANIC NONPOTABLE,SOLID ANALYSIS __ Purgeable Halocarbons (624/8260) ■ ■ ■ {hemodialysis & all others) __ Coliform P/A (Public supplies) jlXWlafile Halocarbons (524) Purgeable Aromatics (624/8260) _i^*^olatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Coliform MPN (priv well, raw, stp) - __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microextractables (504) _ PCB's (Arochlors) (608/8081) _ Microscopic __ Macroscopic _ API __ Pesticides/PCB screen (508) __ PCB as Decachlorobiphenyl (508A) __ Herbicides (SM18/6630,8151) _ Other Pesticides (SMI3/6630) s■ __ Other; - _______________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water mil Refrigerated?yes no __ Carbamate Pesticides (531) Acid Extractables (625/8270) Chlorinated;?yes___ no __ Glyphosate (547) _^se Neutral Extractables (625/8270) _ Diquat (549) _'i/'GC/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) „ Phthalates (606MS) Total Chlorine Res:mg/L: __ Haloacetic Acids (552) __ Other:____________________________ BIBB : pH ___________ __ Other Pesticides (SM18/6630) _UCMRList1 UBIII mu^Bi I ■I RADiOCHEMiCAi... ANALYSIS _ MtBE Only (524) IdBUi __ Radon IB __ Other____________________ :

iNORGANfC ANALYSiS REQUESTED - I ibr _ Color __ Acidity .luminum PptassiuhV; _ Turbidity __ Alkalinity ntimony III „jr^!enium ’'' _ pH __ Bromide rsenic _^Silver __ Conductivity __ Bromate/Chlorate/Chlorite „^''^arium „_^odiurn IB __ Corrosivity (temp:. “C) __ Chloride ^iB'fieryllium jZThallium „ BOD (5 day) __ Cyanide __ Boron Vanadium ill- Carbonaceous BOD (5 day) __ Fluoride .iiLAinc IB „ Soluble BOD (5 day) __ Hardness. Total as CaCOs __ Calcium, as CaCO;- __ Chemical Oxygen Demand Nitrogen, Ammonia as N __ Calcium, Ca'/ Moiais/CN __ Dissolved Oxygen __ Nitrogen. Nitrate as N jztihromium, Total .... Volntiu-s __ Total Organic Carbon __ Nitrogen, Nitrile as N __ Chromium, Hexavalent ... Semi violalilcs H __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N: .ii/tSobalt ....Peslicides/l'!.:|Vs __ Solids, Percent (%) __ Oil and Grease j^rCppper Solids, Settleabie __ Phenol z-rlron ii ISLE __ Solids, Suspended Phosphorus Total as P ..iXead _ TCLP-Metais Solids, Total __ Phosphorus, Ortho as P __ Magnesium _TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates Manganese ___TCLP-Herbicides __ Boiids Tot^ Volatile __ Surfactants .-izf^rcury TCLP-Volatiies Other: "’SA _____ _ UV254 .jEPlvIolybdenum __ TCLP-BNA’s Ml „j,z'l^ckei

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