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 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Time/Date Set: Sample Type (circle one): 1. Potable 3. Non-Potable Treated 2. Non-Potable 4. Other Time/Date Collected: 08I2 Collected By: D. SC.OTT 11.9.01 Agency Code: Collected From: Location's/Individual's Name NYC DEP Street 19 WEST LAKE DRIVE City/St/Zip VALHALLA NY 10595 Identification of Source Collection Point CAT LEFF РrС48c Boь 75 Coglh, QFB42в, 9372,0368 Chain of Custody? к8727, к8728, к8/. Comments: PWS #: Source ID: Type Descriptor:_ Bill to: Name/Company Street City/St/Zip 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 Chiornated?: yes u no Free Chlorine Rest mg/L Total Chlorine Res: _mg/L Lab #: (circle lests) Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) 8 PCB as Decachlorobiphenyl (508A) Herbicides (515) La Pesticides (525) 11. Carbamate Pesticides (531) 12. Glyphosate (547) 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) 15. Haloacetıc Acids (552) 16. Other Pesticides (SM-18/6630) 17. Petroleum/Hydrocarbon Scan (310-13) 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. Petroteum Hydrocarbon Scan (310-13) 10. Glycols in Water 11. Acid Extractables (625/8270) 12, BaseNeutral Extractables (625/8270) 13/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#: (circle tests) 1. Color 2 Turbidity 3 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, otal 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. Surtactants 38. LIV254 27571 39. Aluminum 40. Antimony 41. Arsenic 42. Barium 437 Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCO, 47/ Calcium, Ca 48. Chromium, Total 49. Chromium, Hexavalent muato 51. Copper (52) Iron 53. Lead 54. Magnesium (55/Manganese 56. Mercury 57/ Molybdenum 58. Nickel 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_000070690