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 Time/Date Set: Sample Type(circle one): 1./Potable 3. Non-Potable Treated 2. Non-Potable 4. Other. Time/9ate Collected: Collected By:k Agency Code: Collected From: Location's/Individual's Name NYC D2 Street City/St/Zip necta 2SES Identification of Source Collection Point c L 410 г 9 -71% F669 793Q 791 Bottle #'s: C 062- 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 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 Chiornated .- yes Eno Free Chlorine Res: Lmg/L Total Chlorine Res: Lab #: (circle lests) 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) 9 Herbicides (515) 0) Pesticides (525) 1. Garbamate 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) 1. Color Turbidity 3 4. 5 pH Conductivity Corrosivity (temp:- °C) BOD (5 day) 75 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: 20. Acidity 21. Alkalinity, 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 Surfactants 38.UJV254 27872 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 (57. Molybdenum 58. Nickel NYC-WTC_000070607 :. 24 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Type Descriptor: Fax# Check#: Amounts ORGANIC NONPOTABLE/SOLID ANALYSES Purgeable Halocarbons (624/8260) 2 3 4. 5 6 Purgeable Aromatics (624/8260) Acrolein & Acrylonitrile (624) Phthalates (606/8060) Organochlorine Pesticides (608/8080) PCB's (Arochlors) (608/8080) 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) (3GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) 16. Pesticides (DEF) 17. PCB's (Arochlors) (DEF) Metde (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