Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document Ulestchester 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: 11•12•01 Collected By: D.SCOTT: Agency Code: Collected From: Location's/Individual's Name NYC DEP Street Aulest LAKEIDRIVE City/St/Zip VACHALLA NY 10543 Identification of Source Collection Point Pel lorl Chain of Custody?. Comments: PWS #: Bill to: Name/Company Street City/St/Zip, Phone#: CA, CН, ВI? BACTERIOLOGICAL ANALYSES ORGANIC POTABLE 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 Chiorinated?:_ yes Cno Free Chlorine Res: mg/L Total Chlorine Res: _mg/L Lab #: (circle lests) Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) 5. Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) Herbicides (515) 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) рH INORGANIC ANALYSES REQUESTED -Lab#: (circle tests) -Color 2. Turbidity pH 4 5 6 7 8. Conductivity Corrosivity (temp: °C) BOD (5 day) 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 Other 20. Acidity 39. Aluminum 21. Alkalinity, as CaCO3 40. Antimony 22. Bromide 41. Arsenic 23. Bromate/Chlorate/Chlorite 42. Barium 24. Chloride (43Beryllium 25. Cyanide 44. Boron 26. Fluoride 45. Cadmium 27. Hardness, Total as CaCO, 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N Amoa ds Cs chomi 46. Calcium, as CaCO3 AT) Calcium, Ca*? 48. Chromium, Total 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 32. Oil and Grease 51. Copper 33. Phenol 52> Iron 34. Phosphorus, Total as P 53. Lead 35. Phosphorus, Ortho as P. 54 Magnesium 36. Sulfates (55, Manganese 37. Surfactants 56. Mercury 38. UIV254 (57 Molybdenum 58. Nickel NYC-WTC_000070525 NYS-ELAP No. 10108 K 705ky НІ Р136 РB) kle2o, K7200 Source ID: Type Descriptor:_ Fax #: Check#: Amount$ ORGANIC NONPOTABLE/SOLID ANALYSES 1. Purgeable Halocarbons (624/8260) 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) 12 Base Neutral Extractables (625/8270) / GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) 16. Pesticides (DEF) 17. PCB's (Arochlors) (DEF) Nelds 59 Potassium 60. Selenium 61. Silver (62. Sodium 63.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-Metals 72. TCLP-Pesticides 73. TCLP-Herbicides 74. TCLP.Volatiles 75. TCLP-BNA's