Chain of custody record, Westchester County Labs

NYC 9/11 Public Portal Document ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATÓRIES AND RESEARCH 2 Dana Road. Valhalla, New York 10595 G(914) 593-5575 Time/Date Set: Sample Type (circle one): Polable 3. Non-Potable Treated 20Non-Potable, S 4, Other: Tme/Date Colectedz1002 Coleated BуCRO AH 10.o7 Agency Code Collected From: Location's/Individuars Name NYC DEP Sreet -1O NESTE CARGODEIVE ctysuzip VACHACLA, NV 10545 eidentrication of Source Colécion Point(20 GH Q605 Chain of Custody? Comments: PWS#: Bill to: Name/Company Street. City/StZip Phone#: CA, CH, BI?_ Source ID: BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSEŞ ( circie tests) t. Heterotrophic Plate Count (hemodialysis & all others) Coliform PIA (public supplies): 3 Colform MPN (priv well, raw, stp) 4, Fecal Coliform (all samples) 5 Microscópic Macroscopic 7.APІ3 8. Other: Refrigerated? Chiorinated? yes no yest no Free Chlorine Res: mg/L Total Chlorine Res: mg/L Lab #: (circle tests): Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) 5. Microextractables (504) Pesticides (507) 8: Pesticides/PCB screen (508) :PCB as Decachlorobipheny| (508A) 9 Herbicides (515) : 10 Pesticides (525) 11. Carbamate Pesticides (531). 12. Glyphosate (547) 13. Diquat (549) * 14. Chlorination Disinfection Byproducts (551) 15. Haloacetic Acids (552) 16. Other Pesticides (SM-18/6630) i17. Petroleum/Hydrocarbon Scan (310-13) pH 9717 INORGANIC ANALYSES REQUEȘTED Lab#: (circle teists) 1.Color 2% Türbidity Conductivity Corrosivity (temp: °C) BOD (5 day) Soluble BOD (5 day) Carbonaceous BOD (5 day) Chemical Oxygen Demand o. Dissolved Oxygen 11. Total Organic Carbon 12. Total Organic. Halides 13 Solids, Percent (%) 14 Solids, Settleable 15. Solids, Suspended* 16. Solids: Total Solids, Total Dissolved 185 Solids: Total Volatile 19 Otherte e idity Amalinity, as CaCO3 Bromide 23 Bromate/Chlorate/Chlorite 24 Chloride 25 Cyanide 26. Flüoride 27. Hardness, Total as CaCO3 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N 30: Nitrogen, Nitrite as N 31. Nitrogen, Total Kjeldahl as N 32. Oil and Gréase 33. Phenol " 34. Phosphorus. Total as P: 35. Phosphorus, Ortho as P 36. Sulfates 37. Surfactants 38:UV254 39. Aluminum (40.)Antimony 41. Arsenic 42. Barium Beryllium 44. Boron :i. 45. Cadmium 46, Calcium, as CaCO3 47,Calcium, Ca*2 48. Chromium, Total+ 49. Chromium, Hexavalent (50.)Cobalt "ST. Copper (52) Iron 53. Lead 54) Magnesium 55 Manganese 56. Mercury < 57 Molybdenum :58. Nickel ME NYC-WTC_000071408 eRcu NYS-ELAP No. 10108 Form A:70 (rev. 1796) к8DIь 5875 0480/P677, PFE :Type Descriptor: Fax #: 4 Check#sa Amount$_ ORGANIC NONPOTABLE/SOLID ANALYSES 1Purgeable Halocarbons (624/8260) 2. 3 Purgeable Aromatics (624/8260), 3. Acrolein & Acrylonitrile (624) 4 Phthalates (606/8060) 5.Organochlorine Pesticides (608/8080) 6.J 7. PCB's (Arochlors) (608/8080) .Herbicides (SM-18/6640, 8151) ,8. Other Pesticides (SM-18/6630) .Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water 11. Acid Extractables (625/8270) 12. Base Neutral Extractables (625/8270) JGC/MS. Unknown Scan 4. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) 16. Pesticides. (DEF): 17. PCB's (Arochlors) (DEF) 59 Potassium 60. Selenium 61. Silver® C62 Sodium (63 Thallium (64rVanadium 65. Zinc CLP 66. Metals/CN 67. Volatiles 68. Semi-volatiles 69. Pesticides/PCB's 70. Disk Deliverables ICLP 71. TCLP-Metals 72. TCLP-Pesticides 73. TCLP-Herbicides 74. TCLP-Volatiles 75, TCLP-BNA'S