Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document Westchester County Time/Date Set: Sample Type (circle one): 1. Potable 3. Non-Potable Treated 2. Non-Potable 4. Other Time/Date Collected: O75Es Sco/i Collected By: Collected From: Location's/Individual's Name Nус DEP Street 17 Wesitave Deue City/St/Zip Vitho 1a/ 10575 Identification of Source Collection Point Col toM ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM™ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) PrE-793 P-932 QГB:813a-494 Q.67 Bottle #'s:20561k1C 0991 K-88S9, 3860 v 8644 Chain of Custody? _yes no 11.1501 Agency Code: Comments: PWS #: Source ID Type Descriptor: Bill to: Name/Company Street City/St/Zip Phone#: Fax #: CA, CH. BI? Check#: Amount$ BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab# (circle tests) 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. API Other: Refrigerated? yes no Chiornated?: _ yes Free Chlorine Res: _ no mg/L Total Chlorine Res: mg/L Lab #: (circle lests) 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) 11. 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) 1. Purgeable Halocarbons (624/8260) 2 Purgeable Aromatics (624/8260) 3 4 Acrolein & Acrylonitrile (624) Phthalates (606/8060) 5 6 Organochlorine Pesticides (608/8080) PCB's (Arochlors) (608/8080) 7 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) 13/GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) 16. Pesticides (DEF) 17. PCB's (Arochlors) (DEF) pH 2718 INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity pH Conductivity 5 Corrosivity (temp: _°C) BOD (5 day) 7 Soluble BOD (5 day) 8 Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10 Dissolved Oxygen 11. Total Organic Carbon 12. Total Organic Halides 13. Solids, Percent (%) 14. Solids, Settleable 3. Solids, Suspended 16. Solids, Total 17, Solids, Total Dissolved 18. Solids, Total Volatile 19. Other: 20. Acidity 21. Alkalinity, as CaCO3 22. Bromide 23. Bromate/Chlorate/Chlorite 24. Chloride 25. Cyanide 26. Fluoride 27. Hardness, Total as CaCO3 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N 30. Nitrogen, Nitrite as N 31. Nitrogen, Total Kjeldahl as N 32. Oil and Grease 33. Phenol 34. Phosphorus, Total as P. 35. Phosphorus, Ortho as P 36. Sulfates 37. Surfactants 38. LIV254 39. Aluminum 40. Antimony 41. Arsenic 42. Barium 43. Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCO3 (47. Calcium, Ca"? 48. Chromium, Total 49. Chromium, Hexavalent /50. Cobalt 51. Copper (52.Iron 53. Lead 54, Magnesium 55. Manganese 56. Mercury 57, Molybdenum 58. Nickel Metalo (59. Potassium 60. Selenium 61. Silver 62. Sodium 63. Thallium 164. 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 NYC-WTC_000070277