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Chain of custody record, Westchester County Department of Labs

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Record documenting the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000070404–000070411

Folder label: “27622

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NYC 9/11 Public Portal Document

5 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ter :com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAPNo. 10108 Time/Date Set: Form A-70 (rev.1/96)

(circle one): 6? 67s', 6S76 3. Non Potable Treated Boimra: P-S7l^<R5^.?7?. 2. Non Potable 4. Other___________ Chain of Custody?___yes__ no Time/Date Collected: Comments: Collected By: m Agency Code: PWS#-._____ Source ID: Type Descriptor Collected From: Bill to: Location’s/lndividuars Naim. z> • *7 Name/Company Street_____________ _ _______________ __________ Street...,_____ citv/stzziD * City/St/Zlp„ Identiflcation of - (MMk.M«

BACTERioLC«icALAfUiS5Pl ORGANIC NQNPOTABLE/SOLID ANALYSIS Lab#: '■ ■' (circle tests) ' 1. Heterotrophic Plate 1. Trlhalomethanes (524) 1. Purgeable Halocarbons (824/8260) ' Count (hemocSaiysls& alicrtlteis) 2.yolatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (824) 3. Coliform MPN (privwell, raw,stp) T Total Trihalomethane Potential (510) s' Or^rSotiS^eSSdes (608/8081)' 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Microscopic Pesticides (507) 6. PCB’s (Arochlors) (608/8081) ’ 6. Macroscopic Pesticides/PCB screen (508) 7. Methcprene (616) 7. API PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other.______________ _ 9. Herbicides (515) 9. Pesticides (SM18/6630) yes no (^Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? TT Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) (1^C/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haioacetic Acids (552) IS; Purgeable Halocatbona (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. PestIcldos/PCB's (DEF) 18. Other__________ _ __________ _ 18. Other. 1

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver > 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp;®C) - 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs ^LP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*® 66.Metal8/CN 10. Dissolved Ot^en 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68.Semi-violatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobalt 69.Pesticides/PCB's 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron 15. Solids, Suspended 34. Phosphorus Total as P 53 .Lead ICLE 71 .TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-Posticldos 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73.TCLP-Herblcides 18. Solids, Total Volatile 37. Surfactants 58. Mercury 74. TCLP-Volatiles 19. Other:________________ 38.UV254 67 Molybdenym 76.TCLP-BNA'8 68. Nickel . NYC-WTC_000070410

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NYC-WTC_000070355 · Box DEP Box 61

Record documenting the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

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