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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_000072837–000072840

Folder label: “25947

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Scanned page image, NYC-WTC_000072839
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OCR status: ocr · source: ours

NYC 9/11 Public Portal Document Westchester eov.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: 0900 Collected By: C 12860 10/22/01 Agency Code: Collected From: Location's/Individual's Name муслЕР Street 14 uest lAllE Drive ciy/stzip (h (laulla Mu 10595 Identification of Source Collection Point_De/ 18 NYS-ELAP No. 10 Form A-70 (rev. 1/90 C-03IS K-825C:264,8265,0025 P:9287,92819278 Q.9250.9224,7252 Bottle #s: 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/SOLID ANALYSIS Lab#: (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:?= yes_ no Free Chlorine Res: Total Chlorine Res: - по mg/L mg/L pH Labf: (circle tests) Trihalomethanes (524) 2. Volatile Halocarbons (524) Volatile Aromatics (524) 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. 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. pH 22. Bromide 4. Conductivity 23. Bromate/Chlorate/Chlorite Corrosivity (temp:: °C) 24. Chloride 6. BOD (5 day) 25. Cyanide 7 Soluble BOD (5 day) 26. Fluoride 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. Other: 38. UV254 148 so numnm MctalS (40, Antimony 41. Arsenic 42. Barium (43-Beryllium 44. Boron 45. Cadmium 46. Calcium, as CaCO3 47.Calcium, Ca*2 48. Chromium, Total 49. Chromium, Hexavalent 50 Cobalt 51. Copper 52) Iron 53.Lead 54 Magnesium 55 Manganese 56. Mercury 57)Molybdenum 58. Nickel 59. Potassium 60. Selenium 61. Silver NM (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-BNAS NYC-WTC_000072839

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NYC-WTC_000072839Source: NYC Law Department, mirrored locally

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