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Chain of custody form, Westchester County Labs

Machine-extracted title · confidence 90%

Document tracking the transfer and custody of samples received by Westchester County Department of Labs & Research.

NYC-WTC_000071992–000071999

Folder label: “26470

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Scanned page image, NYC-WTC_000071994
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NYC 9/11 Public Portal Document Westchester gov.com ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 Qse me/Date Set: NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Sample Type (circle one): 1. Potable 3. Non Potable Treated 2. Non Potable 4. Other Time/Date Collectedi 1245 Collected By: h Agency Codem Collected From: Location's/Individuals Name -Ny5 Street R City/St/Zip леяs Identification of Source Collection Point eQu CH G. Bottle #834171 17807174,1142,319 Chain of Gustody72ese0s1337 Comments: PWS #: Source ID: Type Descriptor: Bill to: Name/Company Street City/St/zip Phone#: Fax#: CA,CH, BI? Check#: Amounts BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab# (circle tests) 1. Heterotrophic Plate Count (hemodialysis & all others) 2. Collform P/A (public supplies) 3. Coliform MPNF (priv well, raw, stp) Fecal Coliform (all samples) Vicroscopic Macroscopic API 8. Other: Refrigerated? Lyes Chlorinated:? yes Free Chlorine Res: Total Chlorine Res: mg/L mg/L рH Lab#: (circle tests) Ao Trihalomethanes (524) 2yvolatile Halocarbons(524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 5. Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) teroicides (515) 410. Pesticides (525) 11. Carbamate Pesticides (531) 12. Glyphosate (547) 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) 15. Haloacetic Acids (552) 16. Pesticides (SM18/6630) 17. Petroleum/Hydrocarbon Scan (310-13) 18. Other: 1. Purgeable Halocarbons (624/8260) 2. PurgeableAromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (625/8270) 5. Organochlorine Pesticides (608/8081) 6. PCB's (Arochlors) (608/8081) 7. Methoprene (616) 8. Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630)( 10. Petroleum Hydrocarbon Scan (310-13) 11. Glycols 12. Acid Extractables (625/8270) 13. Base Neutral Extractables (625/8270) (14) GC/MS Semivolatile Unknown Scan 15. Purgeable Halocarbons (DEF) 16. Purgeable Aromatics (DEF) 17. Pesticides/PCB's (DEF) 18. Other: INORGANIC ANALYSIS REQUESTED - Lab#: circle tests) 1. Color 20. Acidity 39. Aluminum munh 2. Turbidity 21. Alkalinity, as CaCOs 40, Antimony 3. рн 22. Bromide 41. Arsenic 4 Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 5. Corrosivity (temp: °C) 24. Chloride 43.Beryllium 6. BOD (5 day) 25. Cyanide -44. Boron 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCOs 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47)Calcium, Ca+2 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 2. Totai Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobalt Solids, Percent (%) 32. Oil an Grease 51.Copper Solids, Settleable 33. Phenol 5. Solids, Suspended 34. Phosphorus Total as P 16. Solids, Total 35. Phosphorus, Ortho as P 17. Solids, Total Dissolved 36. Sulfates 18. Solids, Total Volatile 37Surfactants 19, Other: 38.UV254 53.Lead 54 Magnesium 55 Manganese 56. Mercury 57, Molybdenum 58. Nickel (59, Potassium 60. Selenium 61. Silver, 62. Sodium 63. Thallium 64) Vanadium DBy 65. Zinc CLP 66. Metals/CN 67. Volatiles 68. Semi-violatiles 69. Pesticides/PCB's 70. Disk Deliverables TCLP 71.TCLP-Metals 72,TCLP-Pesticides 73, TCLP-Herbicides 74. TCLP-Volatiles 75.TCLP-BNAS NYC-WTC_000071994

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NYC-WTC_000071994Source: NYC Law Department, mirrored locally

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NYC-WTC_000070606 · Box DEP Box 61

Record documenting the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

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