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Chain of custody form, Westchester County Labs

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Chain of custody record for samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000072362–000072369

Folder label: “25259

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NYC 9/11 Public Portal Document

HL ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 UlM«BheMar(bur«y ’ (914) 593-5575 NYS-ELAP No. 10108 ^le/Date Set; Form A-70 (rev. 1/96) Sample Type (circle one): 1.'/Potable 3. Non-Potable Treated Bottle #’s:p_:____ 2. Non-Potable 4. Other Chain of Custody? yes no Time/Date _______ ) Comments: Collected Ry: 5SZ;/U / regency Code: PWS #;_________ Source ID: Type Descriptor: Collected From: Bill to; Location's/lndividual’s Name. f\} J Name/Company Street__________________ Street__________ City/St/Zip__________ __ City/SVZip______ Identification of Source Phone#: Fax #; Collection Point. a • .f I CA, CH, Bl?. Check#; Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ Lab #;____________________________ (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1, Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2, Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) -.3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4, Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic'^ 6. Pesticides (507) '6,-’ PCB's (Arochlors) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7, Herbicides (SM-18/6640; 8151) .I^AP! EL PCB as Decachlorobiphenyl (508A)' ‘i 8. Other Pesticides (SM-18/6630) ^^^Other;______________ £___ ^Herbicides (515) ' ■ 9. Petroleum Hydrocarbon Scan (310-13) QflJ Pesticides (525) 10. Glycols in Water Refrigerated? yes • no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosale;.(547)' 12. Base Neutral Extractables (625/8270) Chlorinated?: yes no 13. Diquat (549) f^GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) r4; Purgeable Halocarbons (DEF) Free Chlorine Res:. mg/L 15. Haloacetic Acids (552) _ 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) ' 16. Pesticides (DEF) .Total Chlorine Res: mg/L. f 17. Petroleum/Hydrocarbon Scan ;(310-bsi, 17. PCB's (Arochlors) (DEF)

pH ■ . . 4’W INORGANIC ANALYSES REQUESTED - Lab#;. (circle tests) 1. Color 20. Acidity 39. Alu'minfrp 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimd^; 60. Selenium 3. pH 22. Bromide 41. Arsbni^^v 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium^;"^ 62. ^dium 5. Corrosivity (temp: ’C) 24. Chloride 43. Beryllium*’ 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium. 65. Zinc_________________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa Ct£ 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*’ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N ' 49. Chromium. Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N' *' 30.''Cobalt 69. Pesticides/PCB's Solids, Percent (%) 32. Oil and Grease SKCqpper 70. Disk Deliverables______ flBl. Solids, Settleable 33. Phenol ISLE 15. Solids, Suspended 34. Phosphorus. Total as P 53. 71.TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_____________ 38. I.IV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel

A. NYC-WTC_000072364

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NYC-WTC_000072364Source: NYC Law Department, mirrored locally

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NYC-WTC_000071265 · Box DEP Box 61

Document recording the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

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