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Chain of custody record with contact details, Westchester County

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Document recording the chain of custody for samples submitted to the Westchester County Department of Labs and Research including contact information.

NYC-WTC_000070981–000070989

Folder label: “28593

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NYC 9/11 Public Portal Document

UI ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 UJMtehMtar County (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set:_________ Form A-70 (rev. 1/96) Sample Type (circle one): (J^Potable 3. Non-Potable Treated Bottle #’^' F 0 I 6-7 1 2. Non-Potable 4. Other __________________________ Chain of Custody? .yes .no Time/Date Collected:Z/ - J f ? Comments; Collected By: “7 Code: PWS #:_________ Source ID;. Type Descriptor:. Collected From: Bill to. Location’s/lndividual’s Name F7<J Name/Company Street____________________ _______________ "" * _____ Street__________ City/SVZip_________ _____________ __ __________________ City/St/Zip Identification of Source_____________________________ _____ Phone#: Fax #: Collection Point, I CA. CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES . ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_____A_l_:__^l.:_ . . • 'Lab #: (circle tests) . ” . (circle tests) ' 1. Heterotrophic Plate , 1. -Trihalomethanes (524) ' 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) - 2. Coliform P/A (public supplies) 3. Volatile Arorinatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic . 6. Pesticides (507) ‘6. PCB’s (Arochlors) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) j; 8. Other:___________________ 9. 'Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) QO^esticides (525) 10. Glycols in Water Refrigerated? .yes. .00 ■; i lT Carbarhate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 1J2^Base Neutral Extractables (625/8270) Chlorinated?: .yes. .no. .r 13. Diquat (549) . ^J^C/MS Unknown Scan I. 14; Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res: .mg/L' 15; Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: mg/L‘. ' -17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

pH.

INORGANIC ANALYSES REQUE^^ (circle tests) f 1. Color Muminum 59, Potassiurn 2. Turbidity ■ pSAIkalinity, as CaCOs 40. Antimony /So^elenium' 3. pH ^i^^rqmide 41. ^rsenic Silver j 4. Conductivity ■'^3;^ r^ate/Ch lorate/Ch lorite 42.fearium 62. Sodium i I

5. Corrosivity (temp; .“C) ■’^iCh^'ride ^^Beryllium ■^63pThallium 6. BOD (5 day) Boron M. Vanadium 7. Soluble BOD (5 day) 45. Cadmium (1S5>inc 8. Carbonaceous BOD (5 day) 27. Hardness. Total as CaCOa 46. Calcium, as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen. Ammonia as N 47. Calcium. Ca*^ 66. Metals/CN ' 10. Dissolved Oxygen 29. Nitrogen. Nitrate as N /^S^hromium. Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen. Nitrite as N 4^ Chromium. Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen. Total Kjeldahl as N /SO^obaft 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease I 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol I 52. Iron TCLP 15. Solids, Suspended 34. Phosphorus. Total as P I 53Xead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 53^ Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates /55?Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 1^ Other: \ (A________ 38. IIV254 57. Molybdenum 75. TCLP-BNA’s SS/Nickel

NYC-WTC_000070988

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NYC-WTC_000070870 · Box DEP Box 61

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

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