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): 1. Potable 3. Non-Potable Treated 2. Non-Potable 4. Other Time/Date Collected: 0824 Collected By: Di. Sar IT dn•0i Agency Code: Collected From: Location's/Individua's Name JyC DEr Street 4NeTtALE DEive City/St/Zip VANHAWLH D410000 Identification of Source Collection Point AKO f1 NYS-ELAPNo. 10108 Frorm A-70 (rev. 1/96) 1oryoyP2r09,c0 Bottle #'s: iEdo,mark тоетя, килотт, Chain of Custody? yes _no Кр5оА, 42027 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. AP 8. Other: Refrigerated? yes no Chiorinated?: yes Free Chlorine Res: _mg/L Total Chlorine Res: _mg/L Lab # (circle tests) 1. Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) Microextractables (504) 6. Pesticides (507) Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 10/ 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) Purgeable Halocarbons (624/8260) 2 3. 4. 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) 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 1 Calor 2. Turbidity 3 pH 4. Conductivity 5 Corrosivity (temp: °C) 6 BOD (5 day) 7 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 (%) 14, Solids, Settleable 15. Solids, Suspended 16, Solids, Total 17 Solids, Total Dissolved 18. Solids Total Volatile 19. Other a0 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 Surfactants 38. UV254 78106 39. Aluminum 140, Antimony 41. Arsenic 42. Barium 43. Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCOs 47. Calcium, Ca*2 48. Chromium, Tota 49, Chromium, Hexavalent 50,Cobalt 51. Copper 52. fron 53. Lead (54 Magnesium 55. Manganese 56. Mercury (57, Molybdenum 58. Nickel (59 Potassium 60. Selenium 61. Silver 62, Sodium C63.T hallium 64 Vanadium 65. Zinc CLP 66. Metals/CN 67 Volatiles 68. Semi-volatiles 69. Pesticides/PCB's 70 Disk Deliverables TCLP 71. TCLP-Metais 72. TCLP-Pesticides 73 TCLP Herbicides 74, TCLP Volatiles 75HTCLP.BNA's NYC-WTC_000070335