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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

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

III UMtchettar County

wlhie/Date Set: WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAPNo. 10108 ’ Form A-70 (rev. 1/96) -------------------- t z> i /, aj / Sample Type (circle one): Bottle #'s:_x22il£12i^dS 1^Potable 3. Non-Potable Treated Z Non-Potable 4. Other Chain of Custody? yes no Time/Date Collected: _______ Comments: Collected By: Agency Code: PWS #:_________ Source ID: Type Descriptor:. Collected From: Bill to; Location’s/lndividual’s Name Name/Company Street_________________________ Street__________ City/SVZip_____________________ City/SVZip______ Identification of Source Phone#: Fax #: CollectionPoinC 33 I CA, CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLIO ANALYSES Lab#;______________________ L’ab #:_______________________ (circle tests) (drcle 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 Pesticides (507) b '6, PCB’s (Arochlors) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) IjkAPl 8. PCB a^ecachlorobiphenyl (508A) e." 8. Other Pesticides (SM-18/6630) Bother;___________________ 9fc Herbicides (515) ,? 9. Petroleum Hydrocarbon Scan (310-13) <13. Pesticid^(525) •; 10. Glycols in Water Refrigerated? .yes. no 11. Carbamate Pesticides (531) ■f 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) - * Chlorinated?: .yes. no 13. Diq?iat (549) GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res: mg/L 15. Haloacetic Acids (552) , 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) ? yv 16. Pesticides (DEF) Total florine Res; 2.2_ mg/L 17. Petroleum/Hydrocarbon Scan (310-)3)^; 17. PCB’s (Arochlors) (DEF)

£H

INORGANIC ANALYSES REQUESTED - Lab#;. .(circle tests) 1. Color 20. Acidity 39. Aiumiz^rh 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimr^y. 60. Selenium 3. pH 22. Bromide 41. Arseni^f 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. BariunYf-.T 62. Sodium 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 CaCOs CLP 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 50. Cobalt 69. Pesticides/PCB's d 1^. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables Solids. Settleable 33. Phenol 52. Iron TCLP 15. Solids. Suspended 34. Phosphorus. Total as P 53. Lead 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:_____________ 38.1. IV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000072365

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NYC-WTC_000072365Source: 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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