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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_000071530–000071537

Folder label: “27389

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NYC 9/11 Public Portal Document .... .

Hl ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■\ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 UtoctehMtarCourty (914) 593-5575 NYS-ELAP No. 1010^ Time/Date Set: Form A-70 (rev. 1/96) Sample Type (circle one): Y” 773,77 b 77q 6 3. Non-Potable Treated Bottle #’s:0 - Z.M <, A 7 ; ALt 1. PotaBtex ■^’^ori’Pbfable 4. Other_____________ Chain of Custody? .yes no Time/Date Collected:, Comments: ■K? ;( Collected By: — _______ Agency Code; PWS #:_________ Source ID: Type Descriptor:. Collected Froin: /-/. fa Bill to: Location’s/lndiviJual's Name l z. V z y “7 " .'i Name/Company Street_____________ Street__________ City/St/Zip__________ City/St/Zip >* Identification of Source. Phone#: —Fax#: <n I CA. CH Bl? Check#: Amounts. Collection Point -■ V., BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLIDANALYSES Lab#:.______________________ Lab #:_______________________ (circle tests) (circle tests) PI®'® 1. Trihalomethanes (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)' 145 Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractabies (504) 5. Organochlorine Pesticides (6Qfi^080) 5. Microscopic 6^ Pesticides (507) '6. PCB's (Arochlors) (608/8080)W': 6. Macroscopic Q Pesficides/PCB screen (508) ■;.7. Herbicides (SM-18/6640; 81%^.,., 7. AP! - ( >■ PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)^ 8. Other:,1 9,.,^ Herbicides (515) Pesticides (525) Refrigerated? yes no Ik Carbamate Pesticides (531) 11. Acid Extractables (625/8270)', 12. Glyphosate (547) ^Base Neutral Ej^Vdctables (625/8270) d tf Chlorinated?: .yes no 13. Diquat (549) (^GC/MS Unkriov^can ., 14. Purgeable Halc^^ons (DEF) .Vl 14. Chlorination Disinfection Byproducts (551) .■th.. Free.Chlorine Res:. mg/L 15. Haloacetic Acids (552) 15. Purgeable Arorr^'cs (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF)X, Total,Chlorine Res: mg/L-y‘ 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) at/ ..if a. -iv a/ - pH..? -J

INORGANIC ANALYSES REQIUKTEDa’Lab#:_________ ; I /’$■ <■"

(circle tests) 1. Color z Agdity 39. Aluminum ■ '59. PotAssiuf^f^. . h- 2. Turbidity 3. pH 21. AK’alinity, as CaCOa 22. Bromide 40. Antimony 41. Arsenic 60. Selenitim a '/ 61. Silver f -7- '•■"''ll ■■

4. Conductivity B.fbThate/Chlorate/Chlorite 42. Barium 6^. 'Sodium {\ 5. Corrosivity (temp:. ?C) ^4: Chloride 43. Beryllium /.^TH&lliunt ■' ' 6. BOD (5 day) 2^1 Cyanide 44. Boron 7. Soluble BOD (5 day) 26. Fluorid'e 45. Cadmium '®S8^2inc___________ 'I.

8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOa CLP V’ 47. Calcium. Ca*-’ v 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 66. Metals/CN ' 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles ■f- 11. Total Organic Carbpp 5 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent €8. Semi-volatiles 12. Total Organic Halide<y 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69/ Pesticides/PCB's If < 13. Solids, Percent (“Af „ 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. JCLP-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. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel ‘.r .

NYC-WTC_000071536

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NYC-WTC_000071536Source: NYC Law Department, mirrored locally

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