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Chain of custody record, Westchester County Lab, Nov 2001

Machine-extracted title · confidence 90%

Chain of custody form for samples submitted to the Westchester County Department of Labs and Research in Valhalla, NY.

NYC-WTC_000070961–000070965

Folder label: “28468

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Scanned page image, NYC-WTC_000070963
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NYC 9/11 Public Portal Document Time/Date Set: Sämple Type (circle one): .Potable 3. Non-Potable Treated 2. Non-Potable 4: Other Time/Date Collected: 0851 : 11.20•01 Collected By: D). SCOTT: Agency Code: Collected From: Location's/Individual's Name NYC DEP street 19 WEST LAKE DRIVE City/SV/Zip VALHALLA, NY 1595 Identification of Source Collection Point_ AT LEFE ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORMP 14T WESTCHESTER COUNTY LABORATORIES AND RESE ÁRCH 2 Dana Road, Valhalla, New York 10595 :.. (914) 593-5575 NYS-ELAP No 10108* ; Form A-70 (rev. 1/96) Q14, Q915, Q*0945, C0567 BOMe#s P1085, PI09Z, REE1Z KE916 Chain of Custody? KOYC Comments: " _yes ÷no KEU4LBLANK K•VOCTRT PWS #:_ : Source ID: iType Deścriptor:_ Bill to: Name/Company Street City/St/Zip. Phone#: Fax #: CA, CH, BI? Check#: Amounts BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES ￾Läb#: (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?: Free Chiorine Res .YeS_. _now= Total Chlorine Res: _mg/L'; pH Lab #: (circle lests) 4651 Trihalomethanes (524) .1. Purgeable Halocarbons (624/8260) Volatile Halocarbons (524) 2. Purgéable Aromatics (624/8260) Volatile Aromatics (524) Total Trihalomethane Potential (510) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) 5. 6 8. Microextractables. (504) 5. Organochlorine Pesticides (608/8080) Pesticides (507) PCB's (Arochlörs) (608/8080)" Pesticides/P.CB screen (508) 7: Herbicides (SM-18/6640, 8151) PCB'as Dècachlorobipheny! (508A) 8. Other. Pesticides (SM-18/6630): ¿Herbicides (515). 9:, Pefroleum Hydrocarbon Scan (310-13) *Pesticides (525) 10. Giycols in Wấter 11:Carbamate Pesticides (531) 11) Acid Extractables: (625/8270) 12. Glyphosate (547); 12. Base Neutral Extractables (625/8270) 13: Diquät (549) [3/GC/MS Unknown Scan. 14. Chlorination Disinfection Byproducts_(551): 14. Purgéable Halocarbons (DEF. 15. Haloácetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticidés (SM-18/6630) 16. Pesticides (DEF) 17. Petroleum/Hydrocarbon Scan (310-13) 17. P.CB's (Arachlors) (DEF) pretahs INORGANIC ANALYSES REQUESTED BLab#: (circle tests)* Color: 2.:Turbidity 20 idity Alkalinity, as CaCO3 22 4. Conductivity 5. Corrosivity (temp °C) 6:- BOD (5 day), 7Soluble BOD (5 dãy) Cotbonaceoys BOD (s day). Chemical Oxygen Demand. 10. Dissolved Oxygen» 113Total Organic Carbon 12. Total Organic Halides 13 Şölids, Percent (%); '14 Solids" Settleable) .15.Solids; Suspended: :16÷Sölids+Totälı 5117: Solids: Total Dissolved) -18: Solas Totatvoi 19%Other Bromide Bfomate/Chlorate/Chlorite Chioride 25: Cyanide 26. Fluoride" 27. Hardness, Total as CaCOз 28. Nitrogen, Ammonia as N.. 29.Nitrogen, Nitraté as N 30 Nitrogen, Nitrite as N 31 •Nitrögen, Tota! Kjeldahl as N. 32NOiLand Grease" 331Phenội} 34+Phosphorus: Total asPA 35: Phosphorüs, Ortho as P 36 Sulfates, 37, Sürtàcłants) 38 LV254 Tinö 39. Aluminum 40JAntimony 41. 'Arsenic Barium Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCO3 47. Calcium, Cat2: 48. Chromium, Total4, 49. Chromium, Hexavalent 50pCobalt1 51; Copper ron Leadi 54 Magnesiüm3 (55 Manganese; 56Mercury «Molybdenum) .58.Nickeli 59. Potassium 60. Selenium 61:Silver 62. Sodium 63. Thallium 64. Vanadiur 65. Zinc CLP '66. Metals/CN 67 Volatilesy 68. Semi-volatiles x '69 Pešticides/PCB's 170 DisK Deliverables TCLP) 71, TCLP-Metals 72. TCLP Pesticides 73,TCLP Herbicides; ;74!ŤCLР￾Võlätilés! 175.ȚCLP-BNA'Ś NYC-WTC 000070963

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NYC-WTC_000070963Source: NYC Law Department, mirrored locally

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