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Document / 4 pages

Chain of custody record, Westchester County Labs, Oct 2001

Machine-extracted title · confidence 95%

Document tracking the transfer of environmental samples to Westchester County Department of Labs and Research.

NYC-WTC_000072785–000072788

Folder label: “25938

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Scanned page image, NYC-WTC_000072787
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NYC 9/11 Public Portal Document Westchester gov.com ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIESAND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 Time/Date Set: NYS-ELAP No. 10109 Form A-70 (rev.1/9 Sample Type (circle one): 1.Potable 3. Non Potable Treated 2. Non Potable 4. Other Time/Date Collected: Collected By: Wogaer до от Agency Code: - Collected From: Location's/Individual's Name NyC DC P Street 19 Wesilalc Demur City/St/Zip Valhalla NV 10s9s Identification of Source Collection Point 9423. P: 365, P. 9700 CF8-109 0-128,0-209 Bottle #'s: 032 К-23. K-2319 и:0216 Chain of Custody? yes no Comments: PWS #: Source ID: Type Descriptor: Bill to: Name/Company Street City/St/Zip Phone##: Fax#: CA,CH, BІ? Check#: Amount$_ BACTERIOLOGICAL ANALYSIS ORGANIC POTABLEANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#: (circle tests) 1. Heterotrophic Plate Count (hemodialysis & all others) 2. Coliform P/4 (public supplies) 3. Coliform MPN (priv well, raw, stp) 4. Fecal Coliform (all samples) 5. Microscopic 6. Macroscopic 7. APl 8. Other: Refrigerated? Chlorinated:? yes yes Free Chlorine Res. Total Chlorine Res: mg/L mg/L рH 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 20. Acidity 2. Turbidity 21. Alkalinity, as CaCO3 3. рH 22. Bromide 4. Conductivity 23. Bromate/Chlorate/Chlorite 5. Corrosivity (temp: °C) 24. Chloride 6. BOD (5 day) 25. Cyanide Soluble BOD (5 day) 26. Fluoride 8. Carbonaceous BOD(5 day) 27. Hardness. Total as CaCO3 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 11% Total Organic Carbon 30. Nitrogen, Nitrite as N 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 13. Solids, Percent (%) 32. Oil an Grease 14. Solids, Settleable 33. Phenol 15. Solids, Suspended 34. Phosphorus Total as P 16. Solids, Total 35. Phosphorus, Ortho as P 17. Solids, Total Dissolved 36. Sulfates 18. Solids, Total Volatile 37 Surfactants 19 OtherSa 38. UV254 )5939 39. Aumnum(utalS 59. Potassium 40) Antimony 60. Selenium 1. Arsenic 61. Silver Barium 62. Sodium 43 Beryllium Boron 63. Thallium 64. Vanadium 45.Cadmium 65. Zinc 46. Calcium, as CaCos CLP 47 Calcium, Ca*2 66. Metals/CN 48. Chromium, Total 67- Volatiles 49. Chromium, Hexavalent 68. Semi-violatiles 50,Cobalt 69 Pesticides/PCBS 51. Copper 70. Disk Deliverables 52 Iron TCLP 53.Lead ZI TCLP Metad 54 Magnesium 72,TCLP Pesiicides 55 Manganese 73, TCLP:Herbiados 56, Mercury 74,TCLP-Volatles 57) Molyboenum 58. Nickel 75 TCLP-BNAS NYC-WTC_000072787

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NYC-WTC_000072787Source: NYC Law Department, mirrored locally

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

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