Chain of custody form for laboratory samples, Westchester County Lab

NYC 9/11 Public Portal Document Westchester ov.com ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1712 neac NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.10/01) Sample Type (circle one): 1Potable 3. Non Potable Treated Bottle #'s. 186 187,2615,793,1397 2. Non Potable 4. Other Time/Date Collected 11:34 рм 1/25/02 Chain of Custody? Collected By: o. Geit sit Ao 1/25/0t / 0 Yes No Comments: PWS #: Source ID: -Type Descriptor: Collected From: Location's/Individual's Name 02855 Bill to: Name/Company Street Street City/St/Zip City/St/Zip Identification of Source Phone##: Fax#: Collection Point 51250 CA,CH, BI? Check#: Amounts BACTERIOLOGICAL ANALYSIS Lab#t; Heterotrophic Plate Count (hemodialysis & all others) Coliform P/A (Public supplies) Coliform MPN (priv well, raw, stp) Fecal Coliform (all samples) Microscopic Macroscopic API Othert Refrigerated? Chlonnated 2 yes yes ce Free Chiorine Res: Total Chionne Res. mg/L _mg/L PH Lab# ORGANIC POTABLE ANALYSIS Trihalomethanes (524) Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential (510) Microextractables (504) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) Herbicides (515) Pesticides (525) Carbamate Pesticides (531) Glyphosate (547) Diquat (549) Chlorination Disinfection Byproducts (551) Haloacetic Acids (552) OtherPesticides (SM18/6630) UCMR List 1 MtBE Only (524) ORGANIC NONPOTABLE/SOLID ANALYSIS Purgeable Halocarbons (624/8260) Purgeable Aromatics (624/8260) Acrolein & Acrylonitrile (8260) Organochlorine Pesticides: (608/8081) PCB's (Arochlors) (608/8081) Herbicides (SM18/6630,8151) Other Pesticides (SM18/6630) Petroleum Hydrocarbon Scan (310-13) Glycols in Water Acid Extractables (625/8270) Base Neutral Extractables (625/8270) GC/MS Unknown Scan Phthalates (606MS) Other RADIOCHEMICAL ANALYSIS Radon: Other INORGANIC ANALYSIS REQUESTED - Lab# Color Turbidity pH Conductivity Corrosivity (temp:_ °C) BOD (5 day) Carbonaceous BOD (5 day) Soluble BOD (5 day) Chemical Oxygen Demand Dissolved Oxygen Total Organic Carbon Total Organic Halides Solids, Percent (%) Sollds, Settleable Sollds, Suspended Sollds, Tota Solids, Total Dissolved Sollds, Total Votatile Pother: Acidity Alkalinity Bromide Bromate/Chlorate/Chlorite Chloride Cyanide Fluoride Hardness, Total as CaCOs Nitrogen, Ammonia as N Nitrogen, Nitrate as N Nitrogen, Nitrite as N Nitrogen, Total Kjeldahl as N Oil and Grease Pheno Phosphorus Total as P Phosphorus, Ortho as P Sulfates Surfactants UV254 k Aluminum KAntimony J/Arsenic k Barlum k Beryllium Boron Cadmium Calcium, as CaCOs Calcium, Ca*2 Chromium, Total Chromium, Hexavalent TCobalt Copper VLeal Magnesium Manganese LMercury V Molybdenun Nickel FOTaSSUN Selentur o Silver SodIUl Thallu Vanadium TZinc CLP Metals/CN Volatiles Semi-violatiles Pesticides/PCB's ICLP ATCLP-Metais TCLP-Pesticides TCLP-Herbicldes TCLP Volatiles TCLP-BNAS NYC-WTC_000072994