Chain of custody form for submitting environmental samples to a Westchester County laboratory facility.
NYC-WTC_000063018–000063023Folder label: “525”
OCR status: ok · source: pdftotext
NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM r ter i /.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH . ■!<
2 Dana Road, Valhalla, New York 10595 (914)593-5575 . NYS-ELAP No. 10108 Time/Date Set:
Sample Type (circle one): ,1'; Potable^ 3. Non Potable Treated Bottle 2. Nori Potable -4. Other Chainr of Custody?yes ___ no Time/Date Collected: Comments: Collected By: f unn» Agency Code: PWS #:_______ Source ID; Type Descriptor: Collected From: i'l J Bill to; M Location’s/lndividual’s Name Name/Company Street Street City/St/Zip IZ3E3k^Z2Z City/St/Zip Identification of Source Phone#: Fa»J^ Collection Point | 1B CA.CH, BI? Check#; Amounts.
BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC N0NP0TA6LE/S0UD ANALYSIS Lab#: Lab#: ___________ _ (circle teste) (circle teste) 1. Heterotrophic Plate Count (hemodialysis & all others) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) 4. Fecal Coliform (all samples) I Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) Microextractables (504) 1. Purgeable Halocartxrns (624/8260) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (625/8270) 5. Organochlorine Pesticides (608/8081) 5. Microscopic Pesticides (507) 6. PCB's (Arochlors) (608/8081) 6. Macroscopic Pesticides/PCB screen (508) 7. Methoprene (616) 7. API 8. PCB as Decachlprobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other:_____ ■ Herbicides (515) 9. Pesticides (SM18/6630) Refrigerated? yes no Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Carbamate Pesticides (531)- 11. Glycols Chlorinated;? yes no Glyphosate (547) 12: Acid Extractables (625/8270) Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chloriination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan Total Chlorine Res; nig/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) (jg)Other -F ■ 18. Other__________ _ _____________
INORGANIC ANALYSIS REQUESTED - Lab#: (circle teste) . 1. Color 20. A;idity /39i Aluminum . /S? Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40 Antimony 60. Selenium 3. pH 22. Bromide 41 Arsenic I 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 4^Barium JIr 62. Sodium 5. Corrosivity (temp: ®C) 24. Chloride O Beryllium 63. rhallium 6. BOD (5 day) . 25. Cyanide 44. Boron 64/ Vanadium 7. Soluble BOD (5 day) 26. Fluoride Xb^Gadmium Zinc 27. Hardness, Total as CaCOs (^^^ulciuiitras CaCOi- - 8. Carbonaceous Bod (5 day) CLP 28. Nitrogen, Ammonia as N X^alcium, Ca*2 9. Chemical Oxygen Demand 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N (48^hromium, 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 /^0?Cobalt 69.Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. ron TCLP 15. Solids, Suspended 3 4. Phosphorus Total as P 53. .ead 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-Heibicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_________________ 38. UV254 Mybdenum 57 f Lljun.! 75.TCLP-BNA's \58.JHickel
NYC-WTC_000063018
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11 shared non-person entities · 1 shared topics · similarity 0.994
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Chain of custody record for samples submitted to the Westchester County Department of Labs and Research.
11 shared non-person entities · 1 shared topics · similarity 0.994
machine-extracted · confidence unavailable · Check page ↗NYC-WTC_000072168
Record tracking the chain of custody for environmental samples submitted to the Westchester County laboratory.
11 shared non-person entities · 1 shared topics · similarity 0.994
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Document tracking the transfer and custody of samples received by Westchester County Department of Labs & Research.
11 shared non-person entities · 1 shared topics · similarity 0.993
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Record documenting the chain of custody for samples submitted to the Westchester County Department of Labs and Research.
11 shared non-person entities · 1 shared topics · similarity 0.993
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11 shared non-person entities · 1 shared topics · similarity 0.993
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11 shared non-person entities · 1 shared topics · similarity 0.993
machine-extracted · confidence unavailable · Check page ↗NYC-WTC_000072443
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11 shared non-person entities · 1 shared topics · similarity 0.993
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Form documenting the chain of custody for samples submitted to the Westchester County Department of Labs and Research.
11 shared non-person entities · 1 shared topics · similarity 0.993
machine-extracted · confidence unavailable · Check page ↗NYC-WTC_000072522
Chain of custody record for samples submitted to the Westchester County Department of Labs and Research.
11 shared non-person entities · 1 shared topics · similarity 0.993
machine-extracted · confidence unavailable · Check page ↗Similar subjects in other documents. Similarity does not establish the same event, measurement or conclusion.
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