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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

UI ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Ulectchester County (914) 593-5575 NYS-ELAP No. 10108 jP P /<; 1 V FormA-70 (rev, 1/96) Time/Date Set:_________ Sample Type (circle one): 1.- Potable 3. Non-Potable Treated 2. Non-Potable 4. Othor/z_________ , Chain of Custody? .yes Time/Date Collected:. Comments: Collected Bv: Agency Code: PWS #:_________ Source ID: Type Descriptor:. Collected From: BUI to: Location’s/lndividual's Name Name/Company Street________ __________ _____ Street__________ City/St/Zip_____________________ City/St/Zip Identification of Source. Phone#:, _Fax #:, I CA, CH Bl?_ Check#:_____ Amounts Collection Point.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLIO ANALYSES Lab#:__________ . ______ Lab #:____________________________ (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihaiomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) , Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) ' Volatile Aromatics (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 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) 8. Other:_______ ' ______ a 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) . 1Z 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 Chlorin^Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Ros: 17. Petroleum/Hydrocarbon Scan (310-13) ; 17. PCB's (Arochlors) (DEF)

pH

INORGANIC ANALYSES REQUESTED - Lab#: ) ft Hi 4^—1^

(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) 7. Soluble BOD (5 day) 25. Cyanide 26. Fluoride 44. Boron 45. Cadmium 64. Vanadium 65. Zinc 6\ 8. Carbonaceous BOD (5 day) 27. Hardness. Total as CaCOa 46. Calcium, as CaCOs 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 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 ISLE 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. I.IV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel

NYC-WTC_000071190

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NYC-WTC_000071190Source: NYC Law Department, mirrored locally

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