Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document Westchester County- ENVIRONMENTAL SERVICESSAMPLESUBMISSIONFORM 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-PotableTreated 2. Non-Potable 4. Other. Time/Date Collected: Collected By:_ M.IL. 1 A/MN _Agency Code: Collected From: Location's/Individual's Name NNC DEP Street во r- City/St/Zip NI NISC Identification of Source Collection Point 118 к-30, 7133, 30E7 Bottle #s: 21As47 Chain of Custody? yes Comments: PWS#: Source ID: Bill to: Name/Company Street City/St/Zip Phone# CA, CH, BI? BACTERIOLOGICAL ANALYSES ORGANIC POTABLE 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. APL 8. Other: Refrigerated? yes Chiorinated?: yes Free Chlorine Res: mg/L Total Chlorine Res: mg/L рH INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 2 Turbidity pH 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 (%) 14. Solids, Settleable 15. Solids, Suspended 16. Solids. Total 17. Solids, Total Dissolved 18. Solids. Total Volatile 19. Other: Lab #: (circle tesis) 1. Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) 4 5 6 Total Trihalomethane Potential (510) Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) (10)Pesticides (525) 11. 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) 11168 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.UIV254 39. Aluminum 40. Antimony 41. Arsenic 42. Barium 43/ Beryllium 44. Boron 45. Cadmium 46, Calcium, as CaCO3 47. Calcium, Ca*2 48. Chromium, Total 49. Chromium, Hexavalent 50. Cobalt 51. Copper 52. Iron 53. Lead 54. Magnesium 55. Manganese 56. Mercury 57. Molybdenum 58. Nickel NYC-WTC_000070502 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) 66, 600) Type Descriptor: Fax #: Check#: Amounts ORGANIC NONPOTABLE/SOLID ANALYSES 1. Purgeable Halocarbons (624/8260) 2 Purgeable Aromatics (624/8260) 3. 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. Petrolgum 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) Melas 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