Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■ ./SlLl’ : Mir WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 < I JL JCTbWt-- ;i: (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set: ForrnA-70 (rev. 10/01)'

Sample Type (circle one): ./ 1.,potable 3. Non Potable Treated Bottte rs: 2. Non Potable 4, Other_____________ : as Chain of Custody?Yes No

Time/Date Collected: H ‘ '* ' ' Comments;

Collected By: Agency Code: PWS #:, Source ID;: Type Descriptor:

Collected From: Bill to.

L.ocaSion's/lndividuai'a Name Name/Company:

Street: Street:

City/SVZip_______________ j City/St/2ip:

s Identification of Source____ . Collectiorr Point j Phone#:______ :

CA,CH. Bi? Check#: Fax#:

Amounts

CACTERiOi.OGICAL ANALYSIS Lab#:: Lab#:_______ _ __________________ ■ __ Heterotrophic Plate Count ORGANIC POTABLE ANALYSIS __ Trihalomethanes (524) ORGAN S NONPOTABLE/SOLID ANALYSIS __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) Acrolein & Acrylonitrile (8260) ISfflS __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) Fecal Coliform (all samples) ■lii __ Microextractabies (504) „ PCETs (Arochlors) (608/8081) ___ Microscopic _ ... Macroscopic __ Pesticides/PCB screen (508) __ HerDicides(SM18/6630.8151) API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) __ Other:__________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13)' __ Pesticides (525) __ Glycols in Water Wil Refrigerated?____ yes no __ Carbamate Pesticides (531) __ Acid Extractables (625/8270) ■I Chlorinated:? yes no __ Glyphosate (547) z Base Neutral Extractables (625/8270) Diquat (549) __ GC/MS Unknown Scan Free Chlorine Res:j mg/L __ Chlorination Disinfection Byproducts (551) Phthalates (606MS) Oil Ol Total Chlorine Res:; mg/L __ Haloacetic Acids (552) Other:_____________________________ _

pH _____________ __ Other Pesticides (SMI8/6630) LiCMR List 1 ■ RADIOCHEMICAL ANALYSIS __ TUBE Only (524) ___ Radon __ Other_______________________

I ill INORGANIC ANALYSIS REQUESTED - i ni- __ Color __ Acidity _jj-ATuminum Potassium ^11 Turbidity __ Alkalinity .jHAntimony HrSSienium pH __ Bromide .ic'Areenic 2-Silver Conductivity __ Bromate/Chlorate/Chlorite jLrearium -Sodium Corrosivity (temp: .°C) __ Chloride Jur Beryllium _H.-Thallium ii BOD (5 day) __ Cyanide __ Boron __ Vanadium Carbonaceous BOD (5 day) Fluoride __ Cadmium _i^ng ■ I Soluble BOD (5 day) Chemical Oxygen Demand __ Dissolved Oxygen __ Hardness, Total as CaCO:: __ Nitrogen, Ammonia as N __ Nitrogen, Nitrate as N __ Calcium, as CaCOi __ C^cium, Ca*2 H/thromium, Total CLP _ Metals/CN __ Volatiles __ Total Organic Carbon ___ Nitrogen, Nitrite as N Chromium, Hexavalent __ Semi-violatiles

t ■I __ Total Organic Halides __ Solids. Percent (%) __ Solids. Settleable __ Nitrogen, Total Kjeldahl as N __ Oil and Grease __ Phenol — Cobalt Copper _Hlron __ Pesticides/PCB's'

TCLP Solids, Suspended __ Phosphorus Total as P ,_iELead __TCLP-Metals __ Solids, Total Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides ■ __ Solids, Total Dissolved Solids. Total Volatile Sulfates __ Surfactants ■ . 'Manganese •-’'Klercury _ TCLP-Herbicides __ TCLP-Volatites / -<rther: .'E ..2_________ _ ; _ UV254 ji-'Molybdenum _ TCLP-BNAs Nickel

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