Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document ENVIRONMENTAL SERVICES SAMPLESUBMISSIONFORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Westchester County (914) 593-5575 Time/Date Set: Sample Type (circle one): 1. Potable 3. Non-Potable Treated: 2. Non-Potable 4. Other Time/Date Collected: 0620 Collected By: Wagner Collected From: Location's/Individual's Name_ Nyl X P StreetEE WTALGHE DOIVC City/St/Zip nalle Identification of Source Collection Point 799 P- .71- F P: 713 GFe 034 4 627.0 63* Bottle #'s:L:0449, V:8663 Chain of Custody? yes _no H.2-01 Agency Code: Comments: PWS #: Source ID Bill to: Name/Company Street City/SVZip Phone# Fax #: CA, CH. BI2 Check# NYS-ELAP No. 10108 Form A-70 (rev. 1/96 2 Type Descriptor: 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_ Chionnated?: yes no Free Chiorine Res: mg/L Total Chlorine Res: _mg/L Lab #: (circle tests) Trihalomethanes (524) ~ Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) Herbicides (515) Pesticides (525) 1. 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) 12, Base Neutral Extractables (625/8270) 13/GC/MS Unknown Scan 14. 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. ANTurbidity 3. pH 4. Conductivity 5. Corrosivity (temp: °C) 6. 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. Aciaity 21, Alkalinity, as CaCOs 22. Bromide 23. Biomate/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.LIV254 39. Aluminum 40, Antimony 41. Arsenic 42. Barium 43. Beryllium 44. Boron 45. Cadmium 46. Calcium,as CaCOg 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 TN 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 ICLP 71. TCLP-Metals 72. TCLP-Pesticides 73. TCLP-Herbicides 74. TCLP-Volatiles 75, TCLP-BNA's NYC-WTC_000070630