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Document / 9 pages

Chain of custody record, Westchester County Labs, Nov 2001

Machine-extracted title · confidence 90%

Chain of custody documentation for samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000070821–000070829

Folder label: “28688

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Scanned page image, NYC-WTC_000070826
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NYC 9/11 Public Portal Document ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM'3 A H:12 WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Westchester County *ime/Date Set: Sample Type (circle one): 1. Potable 3. Non-Potable Treated 2. Non-Potable 4. Other Time/Date Collected: Lo SO Collected By:V Collected From: Location's/Individual's Name AN/C DCP Street City/St/Zip Veilhellc Anl Identification of Source Collection Point_ (914) 593-5575 NYS-ELAP No. 1015 Form A-70 (rev. 1/9c, с 0729. 4320.267. Рн, 1133 Bottle #s: L 1012,cikc,508, Chain of Custody? yes 11-22-01 Agency Code: Comments: PWS #:_ Source ID: Type Descriptor: Bill to: Diei+ 100 Name/Company Street City/St/Zip Phone#: Fax #: DEl 102 CA, CH. BI? Check#: Amount$ BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#r (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 2 Other, Refrigerated? _yes Chionnated?: _yes Free Chiorine Res: mg/L Total Chlorine Res: mgL Lab #: (circie tests) Trihalomethanes (524) Volatile Halocarbons (524) 3 Volatile Aromatics (524) Total Trihalomethane Potential (510) Microextractables (504) Pesticides (507) 7. Pesticides/PCB screen (508) 8 PCB as Decachlorobiphenyl (508A) 9 Herbicides (515) 10. 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) 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) рH INORGANIC ANALYSES REQUESTED Lab# (circle tests) Color Turbidity 3. pH Conductivity Corrosivity (temp: _°C) BOD (5 day) Soluble BOD (5 day) 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 1. Solids, Suspended i6. Solids, Total 17. Solids, Total Dissolved 18. Solids, Total Volatile 19. Other: 20. Acidity M21 Aikalinity, as CaCOs 22. Bromide 23. Bromate/Chlorate/Chlorite 24, Chloride 25. Cyanide 26. Fluoride 27. Hardness, Total as CaCOs 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. UIV254 39. Aluminum 40/ Antimony ulals 41. Arsenic 42. Barium 43. 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 57. 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. TCLP-Volatiles 75. TCLP-BNA's NYC-WTC_000070826

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NYC-WTC_000070826Source: NYC Law Department, mirrored locally

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