Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document Westchester gov.com ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 Time/Date Set: Sample Type (circle one): 1. Potable 3. Non Potable Treated 2. Non Potable* 4. Other Time/Date Collected: 10.21-01 0818 Collected By: D.s.con Agency Code: Collected From: Location's/Individual's Name NY C DUP Street 9 .) OST LACE DRIVE City/StZip VACHALH NVR595 Identification of Source Collection Point Del18 NYS-ELAP No, 1014 Form A-70 (rev. 1/S P322,20104, PFB,4436k7752, Bottle #'s: C0367 050,08562. GF39445 Chain of Custody?_yes_no K776,K5054 Comments: VOCTRIP BLANK PWS#: Source ID:. Type Descriptor: Bill to: Name/Company Street City/St/Zip Phone#: Fax#: CA,CН, ВІ? Check#: Amount$_ BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Labf: (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 7. API 8. Other: Refrigerated? yes Chlorinated:?sk yes Free Chlorine Res: Total Chiorine Res: mg/ mg/L pH 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) 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. Giycols 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: °C) 6. BOD (5 day) 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 15. Solids, Suspended 16. Solids, Tota 17. Solids, Total Dissolved 18. Solids, Total Volatile 19, Other: S4 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 RAumnum melals 59. Potassium (40. Antimony 60. Selenium 41. Arsenic 61. Silver 42. Barium <62. Sodium 43. Beryllium :63. Thallium 44. Boron (64. Vanadium 45. Cadmium 65. Znc 46. Calcium, as CaCO3 CLP (47.Calcium, Ca*2 66. Metals/CN 48. Chromium, Total 67. Volatiles 49, Chromium, Hexavalent 68. Semi-violatiles (50.Cobalt 69. Pesticides/PCB'S 51. Copper 70. Disk Deliverables (52)Iron TCLP 53.Lead 71 TCLP-Metals <.54 Magnesium (55 Manganese 72. TCLP-Pesticides 73. TOLP-Herbicides 56. Mercury 74, TCLP-Volatiles <57 Molybdenum 75. TCLP-BNAS 58. Nickel NYC-WTC_000072810