Chain of custody form, Westchester County Labs

NYC 9/11 Public Portal Document stchesteri gov.com ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM, WESTCHESTER COUNTY L'ABORAȚORIES AND RESEARCH] 2 Dana: Road, Valhallai New. York 10595 (914) 593-5575 e/Date Set: Sample Type (circle one): (1. Potable 3. Non Potable Treated 2. Non Potable 4. Other Time/Date Collected: 10.23-01- 0908 Collected By: D. ScöTl Agency Code: _:* Collected From: Location's/Individual's Name_ NYC DEP Street . WEST LAKE DRIVE City/St/Zip VALHALLA, NY 10595 Identification of Sourçe Collection Point _ DEL 1O NYS-ELAP, No. 10108 ;Form A-7Ö (rev. 1/96). 29498, {22z, Q68z Botie #'s: (1354, P2028, P:35,PFB20161 Chạin"of Custody? _ yes_ no K4619 Comments: PWS#: _ Source ID: —Type Descriptor: Bill to: Name/Company Street City/St/Zip Phone#: Fax#: CA,CH, ВІ? Check#: Amount$ BACTERIOLOGICAL ANALYȘIS ORGĄNIC POTABLE ANALYSIS Lab#: .(circle tests) 1. Heterotrophic.Plate Count (hemodialysis & all others) 2. Coliform P/A (públic supplies); 3. Coliform MPN , (priv well, raw,; stp) 4. Fecal Coliform (all samples) 5. Microscopic acroscopic 8. Other: Refrigerated? Chlorinated:?. Free Chlorine Res: Total Chlorine Res: рH Lab#: (circle Tests) ,Trihalomethanes) (524) Volatile Halocarbons, (524). Volatile Aromatics (524)} 4. Total Trihalomethane Potential (510): 5.+ Microextractables (504); 6 Pesticides! (507)) Pesticides/PCB screen (508)) 8. PCB as Decachlörobiphenyl}(508A): 10 yes yes no =no: mg/L mg/L „Carbamate" Pesticides (531)} 12. Glyphosate (547); 14.. Chlorination Disinfection Byprodücts (551) 15. Haloacetic Acids, (552) 16: Pesticides (SM18/6630) :17% Petroleum/Hydrocarbon.Scan (310-13) 18.1Other:- INORGANIC ANALYSIS REQUESTED - Läb#: (circle tests) 2baS 1: Color 20.' Acidity* 39. Aluminum 2. Turbidity 21. Alkalinity, as CaCO3 40)Antimony 3. рH 22. Bromide 41. Arsenic 4. Conductivity 5. 23. Bromäte/Chiõrate/Chiorite 42' Bariüm Corrosivity (temp: 6. BOD (5"day) °C) 24!Chloride A3 Beryllium 25. Cyanide 44. Boron 7. Soluble BOD, (5 day) 26. Fluoride: 45'Cadmium: 8. Carbonaceous, BOD4(5,cay) 27. Hardness; Total as CaCÖ3! 46.Calcium, as CaCO3 9. Chemical, Oxygen Demand 28. Nitrogen,"Ammonia as N, 47 Calcium, Cat? i0. Dissolved Oxyğen!*.** 29. Nitrogen, Nitrate as Ni 48. Chromium, Total! 11:;Total_Organic Carbon, 30. Nitrogen, Nitrite as N, 49. Chromitim, Hexavalênt 12. Total Organic Hälides) 31. Nitrogen, Totäl Kjeldahl'as N+ 50 Cobalt® 13/Solids; Percent, (%)! 32:Oi an Grease; 51 Copper: Solids, Settleable: 331Phenolr 52 )ron: Solids Süspended 34Phösphorus Total' as P* 53 Lead 16 Solids, Total) 35: Phosphorus:Ortho as P. 64 Magnesium + 17: Solids: Totál Dissolved; Mänganese*. 8 Solids,, Jotal, Volatile; 37. Surfactants: 56: Mercury) 19Other:!_ 38UV254 572Volybdenumx ,58.Nickel! ORGANIC NONPOTABLE/SOLID ANALYŞIS 1. Purgeable Halocarbons (624/8260) 2. Purgeable Aromatics (624/8260) Acrolein & Acrylonitrile, (624). .4. Phthalates} (625/8270) 5. Organochlorine Pesticides". (608/8081) P.CB's.(Arochlors); (608/8081), Methoprene (616) 8.: Herbioides (EPA1978/8151); : 9:: Pésticides: (SMT8/6630)! 10: Petroleum Hydrocarbon Scän: (310-13) 12.- Acid Extractables: (625/8270)} 13. Base Neutral Extractables,;: (625/8270) 14 GCIMŞ Şemivolatile Unknown Scan . 15. Purgeäble Halocarbons. (DEF) 16. Púrgeable Aromáticsy(DEF) 17: Pesticides/PCB's: (DEF) 18. Other: Tretals 59 Potassium 60. Selenium 61: Silver 62 Sodiumy 63 Thallium 64. Nanadiun 65. Zinc CLP 166: Metals/CN. ¡67) Volătiles 68:Semi-violatiles, j69:Рèsticides/PCВ'ș 170 Disk Deliverables) TCLP 7,1'TCLP-Metals 72 TCLP Pesticides' 73 ȚCLP Herbicides 74} TCLP-Volatiles\ 75ITCLP BNAS! 58 eacpaer Lusao NYC-WTC_000071796