Chain of custody record, Westchester County Department of Labs

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 Date Set: Sample Type (circle one): 1. Potable 3. Non Potable Treated 2. Non Potable* 4. Other Time/Date Collected: Collected By: Agency Code: Collected From: Location's/Individual's Name NYC: DFP Street_11 Iestlake seve City/St/Zip VaibaLLA Ny los9s Identification of Source Collection Point Cutld* NYS-ELAP No. 10108 Form A-70 (rev.1/96) CORROVATI 9146 Bottle #s: ·но,? 3082 ;9-7130,8841 2L06 Chain of Custody?. _ yes Comments: PWS#:. Source ID: Type Descriptor: Bill to: Name/Company Street City/St/Zip Phone#: CA,CH, BI? Check#: Fax#:st4 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) 5. Microscopic croscopic 8. Other: Refrigerated? Chlorinated:7 Lab#: (circle tests) 1Trihalomethanes (524) Volatile Halocarbons (524) 3 Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 5. Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl-(508A) 10. Herbicides (515) Pesticides (525) - yes - yes Free Chlorine Res: Total Chlorine Res: no no mg/E mg/L 11. Carbamate Pesticides (531) 12. Glyphosate (547) 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) 15. Haloacetic Acids (552) 16. Pesticides (SM18/6630) pH 17. Petroleum/Hydrocarbon Scan (310-13) 18. Other. INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 2J050 1. Color 20. Acidity 39. Aluminum 2. Turbidity 21. Alkalinity, as CaCO3 40/ Antimony 3. рH 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 CaCO3 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47.Calcium, Ca*? 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N /50 Cobalt 13. Solids, Percent (%) 32. Oil an Grease 51. Copper Solids, Settleable 33. Pheno 52. Iron Solids, Suspended 34. Phosphorus Total as P 53.Lead 16. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 17. Solids, Total Dissolved 36. Sultates 55 Manganese 18. Solids, Total Volatile 37. Surtactants 56, Mercury 19) Other 38. UV254 (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. 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: nofab 59. Potassium 60. Selenium 61. Silver 62. Sodium 3. Thallium 64. Vanadium 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_000072293