Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document Westchester County 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): L Potable 3. Non-Potable Treated 2. Non-Potable 4. Other Time/Date Collected: Collected By: Agency Code: Collected From: Location's/Individual's Name MYC DCP Street 19 WUEST LACE DRNE City/SvZip Veetteilla 11 10595 Identification of Source Collection Point DEL 10 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) K 8313,04/2 7457, 7728,c owol, Botle#P 1013, 1014,925, 9857,875, 874,872,558 865,876 Comments: PWS#: Billto: Name/Company Street City/St/Zip Phone# CA, CH. BI? Source ID: Type Descriptor: Fax #: 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 AP; 8 Other: Refrigerated? ves no Lab # (circle lests) Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential(510) Microextractables (504) 6. Pesticides (507) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) Herbicides (515) thcrbamete borlatef(s) 12. Glyphosate (547) Chiornated?: yes Free Chiorine Res: no mg/L Total Chlorine Res: mg/L 14. Chlorination Disinfection Byproducts (551) 15. Haloacetic Acids (552) 16. Other Pesticides (SM-18/6630) 17. Petroleum/Hydrocarbon Scan (310-13) Purgeable Halocarbons (624/8260) 2 3. Purgeable Aromatics (624/8260) Acrolein & Acrylonitrile (624) Phthalates (606/8060) 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. Glvcols 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 nuuts INORGANIC ANALYSES REQUESTED - Lab#t: (circle tests 1. Golor 2. Turbidity pH 4 Conductivity Corrosivity (temp: °C) 6. BOD (5 day) 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 15. Solids, Suspended 16. Solids Total 17. Solids, Total Dissolved 18. Solids. Total Volatile OtherCH,1 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. Sultates 37 Surlactants 38 UV254 28105 39. Aluminum 40) Antimony 41. Arsenic 42. Barium (43/Beryllium 44. Boron 45. Cadmium 46, Calcium, as CaCOs (47) Calcium, Ca* 48. Chromium, Total 49 Chromium, Hexavalent Cobalt Copper Iron Lead Magnesium Manganese 66 Mercury Molybdenum 58. Nickel 59 • Potassium 60. Selenium 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 75ATCLP-BNAIS NYC-WTC_000070334