Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Westchester County (914) 593-5575 ime/Date Set: Sample Type (circle one): . Potable 3. Non-Potable Treated 2. Non-Potable 4. Other Time/Date Collected: 08523 15:01 Collected By:nC0ll Agency Code: Collected From: Location's/Individual's Name_ NVC DEP Street" Wesilauo Drue cıy/suZip Valhalla, My 10525 Identification of Source Collection Point FiC Bottle #'s:C0513 Chain of Custody?_ Comments: PWS #: Bill to: Name/Company Street City/St/Zip Phone#: CA, CH. BI? NYS-ELAP No. 10108 Form A-70 (rev. 1/96) P.7941 4-Ч8R 4-8249 K.3922 • VeS.S yes no Source ID: Type Descriptor:_ Fax #: Check#: Amount$ BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: (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, API Other: Refrigerated? yes Chiorinated?: ves Free Chiorine Res: mg/L Total Chlorine Res: _mg/L Lab # Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) 5. Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) Herbicides (515) 19. 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. 2. Purgeable Halocarbons (624/8260) Purgeable Aromatics (624/8260) Acrolein & Acrylonitrile (624) 4 Phthalates (606/8060) 5. Organochlorine Pesticides (608/8080) 6 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 INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) Color 2 Turbidity pH Conductivity 5 Corrosivity (temp: °C) BOD (5 day) Soluble BOD (5 day) Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10. Dissolved Oxygen 11. Total Organic Carbon 12. Total Organic Halides 13. Solids, Percent (%) 1. Solids, Settleable 5 Solids, Suspended 16. Solids, Total 17. Solids, Total Dissolved 18 Solids Total Volatile Other® 20. Acidity 21. Alkalinity, as CaCO3 22 Bromide 23. Bromate/Chlorate/Chlorite 24. Chloride 25. Cyanide 26. Fluoride 27. Hardness, Total as CaCO, 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. Surtactants 38 UV254 27185 39. Aluminum (40) Antimony Arsenic 42. Barium 43J Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCOs 47) Calcium, Ca*? 48. Chromium, Total Chromium, Hexavalent 51 Cooper 52.) Iron 53. Lead 54. Magnesium 55 Manganese 56. Mercury 57) Molybdenum 58. Nickel Motato 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 NYC-WTC_000070278