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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_000071996
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NYC 9/11 Public Portal Document vasrchestel OVC009 ENV FONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH ADana Road, Valhalla, New York 10595 (914) 593-5575 umerpate Set Sampieptype ardelone 1.Potabie E.Non Potable reated 2. Non Potable 4. Other Time/Date Collected: Collected By: 2-27-01 Agency Code: Collected From: Location's/Individual's Name NYC DrP Street 19 Wesilous DRiuc City/St/Zip Valhalla, Ny 10595 Identification of Source Collection Point_De 116 NYS-ELAP No. 10108 Form A-70 (rev.1/96) Botle +s: C0440PFB185,12242K Chain of Custody? - yes •2 3not б5- Comments: PWS #: _ Source ID: .Type Descriptor: Bill to: Name/Company Street City/StZip Phone#: Fax#: CA,CH, BI? Check#: Amount$ BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab# (circle tests) 1. Heterotrophic Plate Count (hemodialysis & all others) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) 4. Fecal Coliform (all samples) Microscopic Macroscopic .API 8. Otner: Refrigerated? Chlorinated:? ves yes Free Chlorine Res: Total Chlorine Res: mg/L mg/L рH Lab#: (circle tests) 1. Trihalomethanes (524) 2.) Volatile Halocarbons (524) / Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 5 Microextractables (504) 6. Pesticides (507) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) Herbicides (515) Pesticides (525) fi carbamaso Pestcdes (S3) 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. INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity 3. pH 4. Conductivity 5. Corrosivity(temp: °C 6. BOD (5 day) 7. Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10. Dissolved Oxygen 11. Total Organic Carbon 12. Total Organic Halides Solids, Percent (%) Solids, Settleable 15. Solids, Suspended 16. Solids, Total 17. Solids, Total Dissolved 18. Solids, Total Volatile 19. Other: 20. Acidity 21. Alkalinity, as CaCO3 22. Bromide 23. Bromate/Chlorate/Chlorite 24. Chloride 25. Cyanide 26. Fluoride 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 an Grease 33. Phenol 34. Phosphorus Total as P 35. Phosphorus, Ortho as P 36. Sulfates 37 Surtactants 38. UV254 39. Aluminum (40? Antimony 41. Arsenic 42. Barium (43)Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCOs 47)Calcium, Cat2 48. Chromium, Total 49, Cnromium, Hexavalent 50/Cobalt 51. Copper 52 Iron 53.Lead 54, Magnesium 55 Manganese 56. Mercury 57 Molybdenum 58. Nickel 1. Purgeable Halocarbons(624/8260) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (625/8270) 5. Organochlorine Pesticides (608/8081) 6. PCB's (Arochlors) (608/8081) 7. Metheprene (616) 8. Herbicides (EPA1978/8151) 9. PesticidesSM18/6630) 10. Petroleum HydrocarbonScan (310-13) 11. Glycols 12. Acid Extractables(625/8270) Base NeutralExtractables(625/8270) 14. GC/MS Semivolatile Unknown Scan 15. Purgeable Halocarbons (DEF) 16. Purgeable Aromatics (DEF) 17. Pesticides/PCB's (DEF) 18. Other: Metus 59) Potasşium 60. Selenium 61. Silver 62, Sodium 63Thailium (64) Vanadium 65. Zinc CLP 66, Metals/CN 67. Volatiles 68. Semi-violatiles 69. Pesticides/PCBs 70. Disk Deliverables TCLP 71.TCLP-Metals 72. TCLP-Pesticides 73. TCLP-Herbicides 74, TCLP-Volatiles 75.TCLP-BNA'S NYC-WTC_000071996

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NYC-WTC_000071996Source: 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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