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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_000072019–000072026

Folder label: “26473

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Scanned page image, NYC-WTC_000072023
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NYC 9/11 Public Portal Document ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 chester County (914) 593-5575 NYS-ELAP No. 10108 ime/Bate Set: Form A-70 (rev. 1/96) Sample Type (circle one): 1-26 2030 2526 0027, 0+04251 Potable 3. Non-Potable Treated Bottle #sQF620, C--415, be sonc, 7u0), тo. 2.- Non-Potable 4. Other. Chain of Custody? Eyes Time/Date Collected: ORYO 10/55/61 Comments: Collected By: MA Afrroad Agency Code: PWS #: Source ID: Type Descriptor: Collected From: Location's/Individual's Name_ NYCDFP/EINSICO Name/Company Street o пiрet ( Dice City/St/Zip Vatilnlla 10595 City/St/Zip Identification of Source Phone#: Fax #: Collection Point 20/,8 CA, CH. BI? Check#: Amount$ BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: (circle lests) 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) 5. Microscopic Macroscopic AP: Other: Refrigerated? yes no Chlorinated?: Lyes no Free Chiorine Res: Total Chlorine Res: _mg/L Lab #: (circle tests) Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) 4 5. 6 Total Trihalomethane Potential (510) Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) 9 Herbicides (515) Pesticides (525) Carbamate Pesticides (531) 12. Glyphosate (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) 1. Purgeable Halocarbons (624/8260) 2. PurgeableAromatics (624/8260) 3 Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) 5. Organochlorine Pesticides (608/8080) PCB's (Arochlors) (608/8080) 7. Herbicides (SM-18/6640; 8151) 8. Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water 11. Acid Extractables (625/8270) 12. Base Neutral Extractables (625/8270) (3. GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) 16. Pesticides (DEF) 17. PCB's (Arochlors) (DEF) pH INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. 2 3. Color Turbidity рH Conductivity Corrosivity (temp:_ °C) 6 BOD (5 day) Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10. Dissolved Oxygen 11. Total Organic Carbon 9. Total Organic Halides Solids, Percent (%) 14. Solids. Settleable 5. Solids, Suspended 16. Solids, Total 17. Solids, Total Dissolved 18. Solids, Total Volatile 9. Other: Sn )1474 Putdo BY 34 20. Acidity 21. Alkalinity, as CaCO3 22. Bromide 23. Bromate/Chlorate/Chlorite 24. Chloride 25. Cyanide 26. Fluoride 27. Hardness, Total as CaCO, 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N 30. Nitrogen, Nitrite as N 31. Nitrogen, Total Kjeldahl as N 32. Oil and Grease 33. Phenol 34. Phosphorus, Total as P 35. Phosphorus, Ortho as P 36. Sulfates 37. Surtactants 38JV254 39. Aluminum 40. Antimony 41. Arsenic 42. Barium 43. Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCOs 47. Calcium, Ca*2 48. Chromium, Total 49. Chromium, Hexavalent 50) Cobalt 51. Copper 52,lron 53. Lead 54. Magnesium 55. Manganese 56. Mercury 57, Molybdenum 58. Nickel 59 Potassium 60. Selenium 61. Siver 62. Sodium 63. Thallium 64. Vanadium 65. Linc CLP 66. Metals/CN 67. Volatiles 68. Semi-volatiles 69. Pesticides/PCB's 70. Disk Deliverables UCLP 71. TCLP-Metals 72, TCLP-Pesticides 73. TCLP-Herbicides 74. TCLP-Volatiles 75, TCLP-BNA'S NYC-WTC_000072023

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NYC-WTC_000072023Source: NYC Law Department, mirrored locally

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NYC-WTC_000070918 · Box DEP Box 61

Chain of custody form for samples submitted to the Westchester County Department of Labs and Research in Valhalla, NY.

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