Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document Westchester County OKV1SP 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) ime/Date Set: Sample Type (circle one): 1. Potable 3. Non-Potable Treated 2. Non-Potable 4. Other, Time/Date Collected Collected By: A/ W/W Agency Code: Collected From: Location's/Individua's Name NyC DEP/KrNSte0 Street 19 Wesilave De.rt Cty/SvZip Vainalla Ny10595 Identification of Source Collection Point R0CH FFL- 944 Cr8IЧ E:188 1LS- 0-490 Bottle #'s:u*71 ,K-8074, K.287s, v-0676 Chain of Custody? no Comments: PWS #:_ Source ID: _Type Descriptor: Bill to: Name/Company. Street City/St/Zip, Phone#: Fax #: CA. СН. BІ? 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. AР Other: Refrigerated? yes no Chionnated?: yes Free Chlorne Res: ПО mg/L Total Chlorine Res: 1_mg/L Lab #: (circle tests) Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potentiat (510) 5 Microextractables (504) Pesticides (507) Pesticides/POB screen (508) PCB as Decachlorobiphenyl (508A) Herbicides (515) Pesticides (525) Carbamate Pesticides (531) 12. Glyphosate (547) 13. Diquat (549) 14. Chlorination Disintection 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) 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) 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) 1. Color 2. Turbidity 3. рH 4. Conductivity 5 Corrosivity (temp: °C) 6 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 (%) 1. Solids, Settleable .o. Solids, Suspended 16. Solids, Total 17. Solids, Total Dissolved 18. Solids, Total Volatile 19Other 2756 20. Acidity 39. Aluminum 21. Alkalinity, as CaCOs 40, Antimony 22. Bromide 41. Arsenic 23. Bromate/Chlorate/Chlorite 42. Barium 24. Chloride (43) Beryllium 25. Cyanide 44, Boron 26. Fluoride 45. Cadmium 27. Hardness, Total as CaCOs 46. Calcium, as CaCO 28. Nitrogen, Ammonia as N 64. Calcium, Ca* 29. Nitrogen, Nitrate as N 30. Nitrogen, Nitrite as N 31. Nitrogen, Total Kjeldahl as N 32. Oil and Grease 33 Phenol hal kodanh oN ec 48. Chromium, Total 49. Chromium, Hexavalent Copper (52) Iron 34. Phosphorus, Total as P 53. Lead 35. Phosphorus, Ortho as P (54) Magnesium 36. Sulfates (55) Manganese 37 Surtactants 56, Meroury 38, UV254 5/ Molyodenum 58. Nickel protas (59) Potassium 60. Selenium 61. Silver 62) Sodium 63. Thallium Vanadium Zinc CLP 66. Metals/CN 67. Volatiles 68. Semi-volatiles 69. Pesticides PCB's 70. Disk Deliverables TCLP 71. TCLP-Metals 12NiCLr-resticides 73. TCLP-Herbicides 74. TCLP-Volatiles 75, TCLP-BNA'S NYC-WTC_000070279