Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document Westchester Counsy ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 Time/Date Set: Sample Type (circle one): 1: Potable 3. Non-Potable Treated 2. Non-Potable 4. Other Time/Date Collected: Collected By: & Wr Agency Code: Collected From: Location's/Individual's Name Street City/St/Zip Identification of Source Collection Point PErY Pfry GLN•CbrD) Bottle #'s:/ 1020 Chain of Custody? yes no Comments: PWS #: Source ID: Bill to: Name/Company Street City/St/Zip. Phone#: CA, CН. BI2 BACTERIOLOGICAL ANALYSES Lablls (circle lests) 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) 5. Microscopic 6. Macroscopic 7. AP, 8, Other: ORGANIC POTABLE ANALYSES Refrigerated? yes Chiorinated?:_ _yes. _no Free Chiorine Res: mg/L Total Chlorine Res: mg/L Lab #: (circie tests) Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) 5. Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) 8 PCB as Decachlorobiphenyl (508A) Herbicides (515) Pesticides (525) Carbamate Pesticides (531) 12. Glyphosate (547) 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) 15. Haloacetic Acids (552) 16. Other Pesticides (SM-18/6630) 17. Petroleum/Hydrocarbon Scan (310-13) PH INORGANIC ANALYSES REQUESTEDabH: (circle tests) 1. Color 20, Acidity 28310 39. Alumınum 2 Turbidity 21 Alkalinity, as CaCo, 40. Antimony 3. pH 22, Bromide 41. Arsenic 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 5 Corrosivity (temp: °C) 24, Chloride 43. Beryllium BOD (5 day) 25. Cyanide 44. Boron Soluble BOD (5 day) 26. Fluoride 45. Cadmium Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO, 46. Calcium, as CaCO3 9 Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca* 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 13, Solids, Percent (%) 32. Oil and Grease 51. Copper 14, Solids, Settleable 33. Phenol 52. Iron 15 Solids, Suspended 34. Phosphorus, Total as P 53. Lead 16. Solids. Total 35. Phosphorus, Ortho as P 54. Magnesium 17. Solids Total Dissolved 36. Sulfates 55. Manganese 18. Solids. Total Volatile 37, Surfactants 56. Mercury voOther 38. UIV254 57. Molybdenum 58. Nickel NYC-WTC_000070248 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Type Descriptor:_ Fax #: Check#: Amounts ORGANIC NONPOTABLE/SOLID ANALYSES 1. 2. Purgeable Halocarbons (624/8260) Purgeable Aromatics (624/8260) Acrolein & Acrylonitrile (624) Phthalates (606/8060) 5. Organochlorine Pesticides (608/8080) PCB's (Arochlors) (608/8080) Herbicides (SM-18/6640; 8151) 8. Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water 11. Acid Extractables (625/8270) 12 Base Neutral Extractables (625/8270) 3: GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) 16. Pesticides (DEF) 17. PCB's (Arochlors) (DEF) Milbo 0 BY 59. Potassium 60. Selenium 61. Silver 62. Sodium 63. Thallium 64. Vanadium 65.Zinc CLP 66. Metals/CN 67. Volatiles 68. Semi-volatiles 69. Pesticides/PCB's 70. Disk Deliverables TCLP 71, TCLP-Metals 72. TCLP-Pesticides 73. TCLP-Herbicides 74. TCLP-Volatiles 75. TCLP-BNA's