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 20 Time/Date Set: Sample Type (circle one): 1. Potable 3. Non-Potable Treated: : 2. Non:Pofable 4. Other. Time/Bate Collected: 0857 Collected By: D.Scoll 11•12.0/ Agency Code: Collected From: Location's/Individual's Name NYC DEP Street 1e) Wost LARE DEIVE City/St/Zip VAteHAILA NV10595 Identification of Source Collection Point DEL18 NYS-ELAP No. 10108 Form A-70 (rey. 1/96) P83O, FFE 049,48098, K6805 Boь22 0581, 06B7075693, (694 Chain of Custody? yes KesoN) AVOC Comments: AUCA PWS #: Source ID: Type Descriptor: Bill to: Name/Company Street City/StZip 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 Chiorine Res: _mg/L Total Chlorine Res: mg/L Lab #: (circle tests) 1. Trihalomethanes (524) 12 Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) 5 Microextractables (504) 6 Pesticides (507) Pesticides/PCB screen (508) 8 PCB as Decachlorobipheny! (508A) 9. Herbicides (515) 1O) 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) 1. Purgeable Halocarbons (624/8260) 2 Purgeable Aromatics (624/8260) 3. 4 Acrolein & Acrylonitrile (624) 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. Petrolęum Hydrocarbon Scan (310-13) 10. Glycols in Water 11. Acid Extractables (625/8270) 12. Base Neutral Extractables (625/8270) 13,JGC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) 16. Pesticides (DEF) 17. PCB's (Arochlors) (DEF) рH INORGANIC ANALYSES REQUESTED - Lab#: (circle tests 1. Color 2. Turbidity pH 4. Conductivity 5 Corrosivity (temp: 6. BOD (5 day) °C) 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. Soiids, Lotal Volatile 19.Other 20. Acidity 21. Alkalinity, as CaCOs 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. Surtactants 38.UJV254 77772 39. Aluminum 40, Antimony 41. Arsenic 42 • Barjum (43/Beryllium 44. Boron 45. Cadmium 40, balclum, as eaco: 47, Calcium, Ca* 48. Chromium, Total 49. Chromium, Hexavalent (50 Cobalt 51, Copper (52/Iron 53. Lead 54/Magnesium 55. Manganese 56, Mercury 57. Molybdenum 58. Nickel Metes (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_000070526