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Document / 3 pages

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_000072760–000072762

Folder label: “25873

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Scanned page image, NYC-WTC_000072761
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OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 2ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH & ov.com 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 i/Date Set: , Form A-70 (rev.1/96) ---- - 7 / , 5'7 7 ? Sample Type (circle one); i. Potable 3. Non Potable Treated Bottle#’6:- ' 2. Non Potable 4. Other Chain of Custody?___ yes___ no Time/Date Collected:/O ■ 7 2 '<• f 9'^1 /k Comments;__________________ Collected By: Agency Code: PWS #: Source ID: Type. Descriptor: Collected From: Bill to: Location’s/lndividual’s Name _ Name/Company Street___________________ J ' Street City/St/Zip________________ ..'.City/St/Zip____ A-*:, . • Identification of Source _____________ Phone#; Fax#: Collection Point _ /b x" >. Check#:

BACTERIOLOGICAL ANALYSIS Lab#;______________________ _ (circle tests) ;(^letests)' 1. Heterotrophic Plate IT Trihalomethan'es (524)* ' 4’ 1. Purgeable Halocarbons *(624/8260) Count (hemodialysis & all others) Volatile Halocarbon's' (524) ‘ ‘ ‘ ' 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics, (524)' .■ 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (privwell, raw.stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) ■ 5. ‘ Micrbextractables (504) 5. Organochlorine Pesticides'(608/8081)' Q 5. Microscopic ' e.' Pesticides (507) <4 ■ 6. PCB’s (Arochlors) (608/8081) , ; .,5, 6. Macroscopic ( 7i Pesticides/PCB screen (508) 7. Methoprene (616) 8.' PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Wrer: 9. Herbicides (515) " ' 9. Pesticides (SM18/6630) (10,'- Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) . Refrigerated?yes ___ no 11. Carbarnate Pesticides' (531) 11. Glycols Chlorinated;? yes___ no 12. Glyphosate (547) 12. Acid Extractables (625/8270) d 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 114)GC/MS Semivolatile Unknown Scan mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res: 16. Pesticides (SMI8/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:____________ _____________ 18. Other: __________ :

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 39. Alurhinum I/WlFc1 ( ■< «

1. Color 20. Acidity J 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40. Antiiflbny 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver . 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 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 CaCOa 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-violatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables l^^lids. Settleable 33. Phenol .... - 52. Iron I^Pblids, Suspended 53.Lead ICLP 34. Phosphorus Total as P 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. UV254 57 Molybdenum 75. TCLP-BNA’s •<•. 58. Nicjcel to At*..

NYC-WTC_000072761

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NYC-WTC_000072761Source: NYC Law Department, mirrored locally

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