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Chain of custody form, Westchester County Dept of Labs

Machine-extracted title · confidence 85%

Form tracking samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000071501–000071504

Folder label: “27288

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Scanned page image, NYC-WTC_000071503
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NYC 9/11 Public Portal Document ÉNVIRÖNMENTAL SÉRVICES SAMPLE SUBMIŞSIÓN FORM WESTCHESTER COUNTY LABORAȚORIES AND RESEARCH ler County 2 Dâna Road, Vålhalla, New Yoik 10595 - (914) 593-5575• Time/Dâté Set: NYS-ELAP No:10108mi Form A-70 (rev. 1/96) Sample Type (circle one): → Potable. 3. Non-Potable Treated 2. Non-Potable •. 4. Other' Time/Date Cöllected: Öx: 2 11:7.01 Collecied By: lfoancr Agency Code: Collected From: Location's/Individual's Name NVC DEP Street:19 Waslloke Dan uC Çity/SVZip_Vadkalla NY 10595 Identification of Source Collection Point Cat icl 6TCIA 49764377 PF8447 P.744P.746. Bote #s: G:0$10 K.8237 K:8738v8735 Chain of Custody?vesn0 .Comments:_ PWS.#:_ _Source ID:_ _ Type Descriptor: Bill to: Name/Company: Street City/SV/Zip. Phone#: Fax#: CA, CH, BI?_ Check#: Amount$ BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab# (circle tests) 1. Heterotrophic Plate Count (hemodialysis & all others) 2. Coliform P/A (püblic süpplies). 3. Coliform MPN (priy well, raw, stp, 4: Fecal Coliform (all samples) 5. Microscopic 6. Macroscopic 8. Other: "Refigérated? Chiorinated?: FreeChiorine Res_ Total: Chlorine Res: pH _ yes_ .'no yes: :nO mg/L: mg/L Lab #: (circle lests) Trihalomethanes (524) Volatile Halocarbons (524). Volatile Aromatics (524) Total Trihalomethane Potential (510) 5. Microexiractables (504) •Pesticides (507) •Pesticides/P.CB 'screen (508) P.CB as Decachlorobipheny! (508A) Herbicides (515) Pèsticides (525) Carbamate Pesticides (531) 12. Giyphosaté (547) 13 Diquat (549), 14: Chlorination Disinfection Byproducts (551) •15. Haloacetic Acids. (552) 16.Other Pesticides (SM-18/6630) 17. Petroleum/Hydrocarbon Scan (310-13) 2. Purgeable Halocarbons (624/8260) Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060): 5: Orgänochlorine Pesticides (608/8080) 6:. PCB's (Arochlors) (608/8080) 7. Herbicides,(SM-18/6640; 8151) 8. Other. Pessticides (SM-18/6630); .9; Petroleum Hydrocarbon Scan (310-13) • 10. Glycols' in Water. 1Ï„Aсïd"Éxträčtáбịếs¡(625/827Õ); 12. Base"Neutral Extractables' (625/8270): (3GCİMŠ Ünknown Scan; 4. Purgeable Halocarbons (DEF): 15. Pürgeable"Aromatics, (DEF) : 16. Pesticides (DEF)* 17. PCB's (Aröchlörs) (DEF)' INORGANIC ANALYSES REQUESTED - Lab#: = (circle tests) .1. Color 2. Turbidity. 3. pH :Conductivity Corrosivity (temp:_ °C) BOD (5 day) : Soluble BOD (5 day) Carbonaceous BOD™(5 day) Chemical Oxygen Demand iot Dissolved Oxygent +11. Total Organic Carbon;, 12! Total Organic Halides" *13 Solids; Percent (%). 14° Solids: Settleable 15: Solids› Suspended! 16! Solids: Total! 174 Solids: Tötal Dissolved) 18ł-Solidș; Totäl:Vòlàtile Other: 20. Acidity 21. Alkalinity, as CaÇO3 22. Bromide 23: Bromate/Chlorate/Chlorite 24. Chloride 25. Cyanide 26. Fluoride 27 Hardness, Țofal as CāCO 28:Nitrogent Ammonia as N 291Nitrogen Nirate as N7 30\Nitrogen, Nitrite as N,- 31:Nitrögen Total Kjeldahl as.N! 32, Oil and Grease; 33Phénói) 34kPhosphorüs.yTotalas:P 35. Phosphorus Ortho asiP› 36ł:Sülfãtēs› 37: Sürfactants: 384UV254 39. Aluminum SOi Artimony Arsenic 2 . Barium 43 Beryllium 44: Boron : 45. Cadmium 46; Calcium, as CaCO3 Calcium, Ca*?. 48: Chrốmium, Total, Chromium, Hexavalent Cobatt: 1:Copper )Iron≥ 3.Lead! ). Magnesium» Manganese] 6xMercury Molybdenum: NickelE metats 159. Potassium ((41 60. Selenium 61. Silver (62 Sodium (63) Thallium 64l Vanadium: 65.Zinc CLP: "66. Metäls/CN 18e; soni Voaiesi, •69. Pesticides/PCB'Š, 70. Disk Deliverables TCLP) там тт (71NTCLP Mètals: (72 TCEP-Pesticides) 73.TCLP-Herbicides; 74: TCLP Volatiles) 75: TCLP-BNA'S; zaxbzan zcifar NYC-WTC_000071503

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NYC-WTC_000071503Source: NYC Law Department, mirrored locally

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