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Document / 8 pages

Chain of custody record, Westchester County Lab, Nov 2001

Machine-extracted title · confidence 95%

Form documenting the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000071089–000071096

Folder label: “26827

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Scanned page image, NYC-WTC_000071096
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NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

HL UlMichMlarbunty

|^/Date_Set_________ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla. New York 10595 (914)593-5575 ' { - j' NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Sample Type (circle one): , VS r V 7 ,1. Potable 3. Non-Potable Treated i 5 2- - . f -I 2,'1 <<Z> 2. Non-Potable 4. Other Chain of Custody? .yes no Time/Date Collectod:_______________ ~ I iL-iL. . Comments: Collected Bv: / ■ ■ V- / Agency Code: PWS #:_______ Source ID:. Type Descriptor: Collected From: Bill to: Location's/lndividual’s Name. / / Name/Company. Street_______ ___________ Street City/SVZip____________ City/St/Zip Identification Of Source:____ Phone#:_____ ■_ _Fax #:_ Collection Point. / I CA. CH. Bl? Check#: Amount^

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_______2___________ Lab #:_________ _______________ _ (circle tests) _. ' . (circle tests) 1. Heterotrophic-Plate Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis. & ail others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein_& Acrylonitrile (624)’ 3. Coliforrp'MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecsi Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. PCB's (Arochlors) (608/8080) 6. f^troscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) . 10. Glycols in Water Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) ^ Base Neutral Extractables (625/8270) Chlorinated?: .yes no 13. Diquat (549) ; ^GC/MS Unknown Scan 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: J__ mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

pH

INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color — 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: .“C) 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc__________ 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 48. Chromium. Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium. Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kieldahl as N 50. Cobalt ___ 69. Pesticides/PCB's t^^ohds. Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables ^Bolids, Settleable 33. Phenol 52. Iron T£L£ l^^olids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54. 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 19. Other:_____________ 38. I. IV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

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NYC-WTC_000071096Source: NYC Law Department, mirrored locally

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