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Chain of custody form, Westchester County Labs, Oct 2001

Machine-extracted title · confidence 95%

Fragmented chain of custody record for samples submitted to Westchester County Department of Labs and Research.

NYC-WTC_000072661–000072664

Folder label: “25791

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Scanned page image, NYC-WTC_000072662
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NYC 9/11 Public Portal Document Wesrchester rov.com ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York10595 (914) 593-5575 Time/Date Set: NYS-ELAP No. 10108 Form A-70 (rev.1/96) Sample Type (circle one): 1. Potable 3. Non Potable Treated 2. Non Potable 4. Other Time/Date Collected: Collected By: Wagner /10.19.01 Agency Code: Collected From: Location's/Individual's Name NyC DEP Street19 WosllaueDeule Citystzip Valhalla Ny 10595 Identification of Source Collection Point_CRO GH QFB 1737440 93bo 0 7356 A-F6-9399 P-9393 P-9312 Bottle #s: (094) и-таа н.4649 Chain of Custody? yes Comments: PWS # Source ID: Type Descriptor: Bill to: Name/Company Street City/St/Zip Phone#: Fax#: CA,CH, BI? Check#: Amount$ BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLIDANALYSIS Labi: (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 6. Macroscopic ner Refrigerated? Chlorinated:? Free Chlorine Res: yes yes no mg/L mg/L Total Chlorine Res: pH S1 Lab#: (circle tests) 1. Trihalomethanes (524) 2. Volatile Halocarbons (524) 3/ Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 5. Microextractables (504) 6. Pesticides (507) 7. Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 10. Pesticides (525) 11. Carbamate Pesticides (531) 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: 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: INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity 3. рH 4. Conductivity 5. Corrosivity(temp: 6. BOD (5 day) °C) 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 13. Solids, Percent (%) 14. Solids, Settleable Solids, Suspended Solids, Total 17. Solids, Total Dissolved 18, Solids, Total Volatile 19. Otheri-SA, nutars 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. Surfactants 38. UV254 39. Aluminum O.Antimony Arsenic 42. Barium 13. Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCO3 47.Calcium, Ca*2 48. Chromium, Total 49. Chromium, Hexavalent 50 Cobalt 1. Copper 52,Iron 53.Lead 54 Magnesium 155 Manganese 56. Mercury 57 Molybdenum 58. Nickel 59} Potassium 60. Selenium 61. Silver 62.) Sodium 63 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-BNA'S NYC-WTC_000072662

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NYC-WTC_000072662Source: NYC Law Department, mirrored locally

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NYC-WTC_000070629 · 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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