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 BY Westchester County (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Sample Type (circle one): J. Potable 3. Non-Potable Treated: 2. Non-Potable 4. Other Time/Date Collected: C815 Collected By: Nugaer Collected From: Location's/Individual's Name NYC_ DEP Street 1 Westlave prive City/St Zip Vatnalla Ny 10S i3 Identification of Source Collection Point Ccd diH РТСаЧУЕИ Sese VEESItaYi Form A-70 (rev. 1/96) PES T01, P.074, P-B75 Bottle #sC-0639.05c • 797.0-772,4 739 Chain of Custody? yes ano 1A461 Agency Code: Comments: PWS #:_ Source ID: Type Descriptor: Bill to: Name/Company Street City/St/Zip Phone# Fax #: CA, CН. BІ? Check#: Amount$ BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: (circle tests) 1. Heterotrophic Plate Count (hemodialysis & all others) 2. Coliform PIA (public supplies) 3. Coliform MPN (priv well, raw, stp) 4. Fecal Coliform (all samples) 5. Microscopic 6. Macroscopic 7. AP 8. Other. Refrigerated? Lyes. Chiornated?: Free Chlorine Res: Total Chlorine Res: no mg/L mg/L Lab #: (circle tests) 1. Trihalomethanes (524) 2.)Voltile Halocarbons (524) Volatile Aromatics (524) 4. 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) 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. Petrofeum 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) рH INORGANIC ANALYSES REQUESTED - Lab#: (circie tests) 1. Color Turbidity ph Conductivity 5 Corrosivity (temp:_ °C) 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: 20. Acidity 21. Alkalinity, as CaCOs 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. Surtactants 38 L/V254 27873 39. Aluminum 40. Antimony 41 Arsenic 42 Barium Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCO3 47, Calcium, Ca* 48 Chromium, Total 49 Chromium, Hexavalent 50. Cobalt 51. Copper 52. Iron 53. Lead 54. Magnesium 55, Manganese 56. Mercury (52. Molybdenum 58. Nickel (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 TCEP-Volatiles 75. TCLP-BNA'S NYC-WTC_000070608