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 A )v.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 , ( 6/^, C OlO, NYS-ELAPNo. 10108 .^.■;^me/Date Set:
Sample Type (circle one): iPotable 3, Non Potable Treated Bottle #’s: Non Potable 4. Other Chain of Custody? ><. yes no / fl ^ime/Date Collected: Comments:
0/ I ^Collected By: Q i
J Collected From: Location’s/lndividuars Name Agency Code: PWS #:______ Bill to: Name/Company Source ID; Type Descriptor
Street K Street________ citv/st/ZiD , KJ "/ City/St/Zip Identification of Source _ ______ ______ ________ Phone#: Fax#: Collection Point CnVXjlII . CA.CH, Bl? Check#; Amounts.
(j Organic NONPOTABLE/SOLID analysis BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS Lab#: __________ Lab#;. (circle tests) (circle tests) 1. Heterotrophic Plate (krunt (hemodialysis & ail others) 01 Trihalometbenes^l524) Volatile Halocarbons (524) \ Purgeable Halocarbons (624/8260) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) X Total Trihalomethane Potential (510) 4. Phthalates. (625/8270) 4. Fecal Coliform (all samples) Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic V Pesticides (507) 6. PCB's (Arochlors) (608/8081) 6. Macroscopic Pesticides/PCB screen (508) 7. Methoprene (616) k API 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI 978/8151) Other:_______________ _ (^ Herbicides (515) 9. Pesticides (SM18/6630) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) lefrigerated? yes no Carbamate Pesticides (531) 11. Glycols ;htorinated:? yes no Glyphosate (547) 12. Acid Extractables (625/8270) ^Diquat (549) 13. Base Neutral Extractables (625/8270) Chlorine Res;. mg/L Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatiie Unknown Scan >tal Chlorine Res: mg/L 15. Haioacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) (18.'pther:^H^;j,|J D£5-tbr^^ 18. Other_______________________
RGANiC ANALYSIS REQUESTED - Lab#: te tests) ri. Color 2O.Ycidity Aluminum Potassium F2. Turbidity 21. Alkalinity, as CaCOs 40.1Antimony / 60 Selenium b. pH ' 22. Bromide 41. Arsenic 61 Silver 14. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 15. Corrosivity (temp: =C) 24. Chloride 43. iryllium 63, Thallium 6. BOD (5 day) 25. Cyanide Boron ‘64./ Vanadium I 7. Soluble BOD (5 day) 26. Fluoride (JSlJDadmium Zinc 4 n I 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs "ELE I 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N ^^alcium, Ca*2 - 66. Metals/CN j 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N Q^yhromium, Total 67. Volatiles 1 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49?Chromium, Hexavalent 68.Semi-yiotatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N ^jCobalt 69. Pesticides/PCB’s 13. Solids. Percent (%) 32. Oil an Grease 51 Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52 Iron leLP 15. Solids, Suspended 34. Phosphorus Total as P 53 Lead 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 57 Molybdenum 75.TCLP-BNA’s 58/Nickel
NYC-WTC_000063022
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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 0.995
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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 0.994
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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
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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
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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