Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Westchester County (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: r Form A-70 (rev. 1/96) Sample Lype (circle one): 1. Potable 3. Non-Potable Treated 17,PF6726 P85 P730 2. Non-Potable 4. Other Chain of Custody? _yes L no Time/Date Collected: 0917 11-12•01 K7745,06507 Comments: Collected By: D 5:6 Agency Code: PWS #:_ Source D. Type Descriptor: Collected From: Bill to: Location's/Individual's Name NVC DEP Street 19 Wert LACE RIVE Name/Company Street City/St/Zip VALHALLA N050T City/St/Zip Identification of Source Phone# Fax #: Collection Point+ CATLEEE CA, CH, BI? Check#: Amount$ DIS 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 Chionnated?: _yes no Free Chiorine Res: mg/L TotalChlorine Res: _mg/L Lab #: (circle tests) Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) 5. Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) Herbicides (515) Pesticides (525) . 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) 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. Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water 11. Acid Extractables (625/8270) Base Neutral Extractables (625/8270) GC/MS Unknown Scan 4. 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. pH 4. Conductivity 5 Corrosivity (temp: °C) 6 BOD (5 day) 7. Soluble BOD (5 day) Carbonaceous BOD (5 day) 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, OtherSp1a) 20. Acidity 21. Aikalinity, as CaCO3 22. Bromide 23. Bromate/Chlorate/Chlorite 24. Chloride 25. Cyanide 26. Fluoride 27. Hardness, Total as CaCO3 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. Surlactants 38. UIV254 7/10 39. Aluminum (40. Antimony 41. Arsenic 42. Barium 43. Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCOs 47/Calcium. Ca*2 48. Chromium, Total 49. Chromium, Hexavalent (50. Cobalt 51. Copper 52 Iron 53. Lead 54 Magnesium (55. Manganese 56. Mercury 7Molybdenum 58. Nickel Muds 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 NYC-WTC_000070524