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 Lype (circle one): 1. Potable 3. Non Potable Treated 2. Non Potable 4. Other Time/Date Collected: _ 1000) Collected By: (URCID 10/22/01 Agency Code: Collected From: Location's/Individual's Name Street _ 12 00 City/St/Zip Vohalle Identification of Source Collection Point M/C DEP LALLE DLIN лу 10595 CROGH NYS-ELAP No. Form A-70 (rev.1/96) C-0531 Kº 3600.2205,1253 1-9258 725C,7298 Q-9261,9220,9238 Bottle #s: Chain of Custody? _yes. Comments: PWS#: Source ID:_ Type Descriptor: Bill to: Name/Company Street City/St/Zip Phone#: Fax#: CA,CH, ВІ? 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? Chlorinated:? yes yes Free Chlorine Res: Total Chlorine Res: -пo _ no _mg/L mg/L рH Lab#: (circle tests) 1oTrihalomethanes (524) Volatile Halocarbons (524) 3./Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 5. Microextractables (504) Pesticides (507) Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) Herbicides (515 1o. 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) 4. 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 pH 4. Conductivity 5. Corrosivity (temp: °C) BOD (5 day) 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 15. Solids, Suspended 16. Solids, Total 17. Solids, Total Dissolved 1c. Solids, Total Volatile 19. Otherte Sи 20. Acidity 25944 Aluminum mulas 59. Potassium 21. Alkalinity, as CaCO3 (40 Antimony 60. Selenium 22. Bromide 41. Arsenic 61. Silver 23. Bromate/Chlorate/Chlorite 42. Barium 62) Sodium 24. Chloride 43. Beryllium ) Thallium 25. Cyanide 44. Boron Vanadium 26. Fluoride 45. Cadmium 65. Zinc 27. Hardness, Total as CaCO3 46.Calcium, as CaCOз CLP 28. Nitrogen, Ammonia as N 7.Calcium, Ca*2 66. Metals/CN 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-violatiles 31. Nitrogen, Total Kjeldanl as N 50 Cobalt 69. Pesticides/PCB's 32. Oil an Grease 51. Copper 70. Disk Deliverables 33. Phenol: 52Iron 34. Phosphorus Total as P 53.Lead TCLP 35. Phosphorus, Ortho as P 54) Magnesium 71.TCLP-Metals 36. Sulfates 55 Manganese 72. TCLP-Pesticides 37. Surfactants 56. Mercury 73. TCLP-Herbicides 38. UV254 57 Molybdenum 74, TGLP-Volatiles 58. Nickel 75. TCLP-BNA'S NYC-WTC_000072840