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
lU ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
tUesfenesteTtoufty WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 7
'' NYS-ELAPN0JOIO8 H Time/Date Set: 7 Fo.rm A-70 (rev. 1/9€)~ Sample Type (circle one): Potable 3. Non-Potable Treated Bottle <f’s: - - - ■ f st* '
2. Non-Potable 4. Other, _ Chain of Custody? .yes .no Time/Date Collected: Comments: Agency Code:. - PWS#;_______ __ Source ID:, .Type Descriptor:. Collected From: • Bill to: / Location's/lndividual’s Name 1 Name/Comoanv Street.1^ . - Street^ ■Gity/Sl®p3^UaAilA.3iLZU^ x Citv/St/Zio Identification of Source Phone#: Fax #:, Collection Pointy . |CA,CH. BI? Check#:. Amounts.
BACTERIOLOGICAL ANALYSES ORGANIC POTTLE ANALYSf:;s ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:__________ _ __________ Lab#: (Jt (drde tests) (circle tests) | 1. Heterotrophic Plate Count (hemodialysis & ail others) 2. Coliform P/A (public supplies) I Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) 1, Purgeable Halocarbons (624/8260) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other:_______________ _ Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) pesticides (525) 10. Glycols in Water Refrigerated? .yes____ _no .Carbamate Pesticides (531) 11. Acid Extractables (625/8270) Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: yes rio 3. )3iquat (549) 13. GC/MS Unknown Scan Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. .mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: mg/L 17.' Petro^nVHydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)
pH
INORGANIC ANALYSES REQUESTED - Lab#:, (circle tests) 1. Color 20. Acidity Aluminum /59, Potassium 2. Turbidity 3; pH 4. Conductivity 21. Alkalinity, as paCOs 22. Bromide 23. Bromate/Chlorate/Chlorite Antimony Arsenic Barium ' /s Selenium Silver 62. Sodium 5. Corrosivity (temp; .’C) 24. Chloride Beryllium > 63. rhallium 6. BOD (5 day) 25. Cyanide . .. Boron 64. vanadium 7. Soluble BOD (5 day) 26. Fluoride r^^Cadmium ' 65/Zinc, -t Sa 4 7; ' 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa 9. Chemical Oxygon Demand 28. Nitrogen, Ammonia as N /47?)Calcium, Ca*’ 66.Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N \4^Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen. Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N -'SOj Cobalt 69. Pesticides/PCB's 13. Solids. Percent (%) 32. Oil and Grease 51jCopper 70. Disk Deliverables 14. Solids, Settleable j 33. Phenol 52. Iron TCLP 15. Solids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TGLP-Metala 16. Solfds, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides '16. Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:______ ,_____ ’ 38. UV254 57. Molybdenum 75. TCLP-BNA’s 58/Nickel
NYC-WTC_000063021
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NYC-WTC_000070404
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 0.995
machine-extracted · confidence unavailable · Check page ↗NYC-WTC_000071898
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 0.994
machine-extracted · confidence unavailable · Check page ↗NYC-WTC_000070783
Chain of custody documentation 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_000072603
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
machine-extracted · confidence unavailable · Check page ↗NYC-WTC_000071817
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
machine-extracted · confidence unavailable · Check page ↗NYC-WTC_000070355
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
machine-extracted · confidence unavailable · Check page ↗NYC-WTC_000071655
Form tracking 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_000071567
Form tracking 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_000072443
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 ↗NYC-WTC_000071089
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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