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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_000071184–000071191

Folder label: “26982

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NYC 9/11 Public Portal Document V''

Hl ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Utadchecter County (914)593-5575 . , NYS-ELAP No. 10108 Time/Date Set:________ _____________________________ _______________ ■ *v /■ > ' f - ' Form A-70 (rev. 1/96) ^jj^mple Type (circle one): . S- ■' '-i Li I '6 1. Notable 3. Non-Potable Treated Bottle y A / 1 V V X. '^Non-Potable 4. Other,____---------------------------------- yes no Chain of Custody? .Time/Date Onllente^ — Comments: Collected Ry: Agency Code: PWS #:_________ Source ID: Type Descriptor:, Collected From: i i t 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#: Amounts

BACTERIOLOGICAL ANALYSES « ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_________ _ _________ _ Lab #:_________________ ______ (circle tests) {circle lests) 1. Heterotrophic Plate , , 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis. & all others) 2. Coliform P/A (public supplies) 3. Coliform MPN (priy .well, raw, stp) © Volatile Halocarbons (524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) 4; Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 5. Microscopic 6. Macroscopic 7. AP! 5. 6 Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) 7. Herbicides (SM-18/6640; 8151) 8. Other Pesticides (SM-18/6630) 8, Other:_______________ ^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) IX 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.„Haloacetiq Acids (552) 15. Purgeable Atomatics (DEF) 16. Other Pesticides (SM-1^6630). 16. Pesticides (DEF| Total Chlorine Res: .mg/Lz 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

Pkt . O t;/-- ---- INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. T urbtdity 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 . I 7. Soluble BOD (5 day) ' 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs CL£ 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 Kjeldahl as N 50. Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron TCLP 15. Solids. 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. IIV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000071186

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NYC-WTC_000071186Source: NYC Law Department, mirrored locally

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