Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM PI2: WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Westchester County (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 1/96) Sample Type (circle one): Q 682, Qrp 498, 8502, K680k, К98С 1. Potable 3. Non-Potable Treated Bottle #'s: CC6iO, PFGTA, P5E, 1574 2. Non-Potable 4. Other. Chain of Custody? _yes Time/Date Collected: 0426 11.9.01 Comments: no KeEcoy кvocтeir DHANK Collected By: D. SCOT Agency Code: PWS #: Source ID: Type Descriptor: Collected From: Bill to: Location's/Individual's Name NVC DET Street 19 vlest cAke DRIVE Name/Company Street City/St/Zip VALHALLA NY 10505 City/St/Zip Identification of Source Phone#: Fax #: Collection Point (26 GH 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 Chionnated?: Free Chiorine Res: yes. а nо 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) 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. 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) pH INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity рH 4. Conductivity 5 Corrosivity (temp: °C) 6. BOD (5 day) Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) Chemical Oxygen Demand 10. Dissolved Oxygen 11. Total Organic Carbon 12. Total Organic Halides21 13. Solids, Percent (%) 14. Solids, Settleable 15. Solids, Suspended 16. Solids, Total 17. Solids, Total Dissolved 18. Solids, Total Volatile 19 Otherat 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. LIV254 570 39. Aluminum 40, Antimony 41. Arsenic 42. Barıum 43 Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCOs (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 Met o 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_000070689