Chain of custody record, Westchester County Dept of Labs, Jan

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) 231-1620 Fax (914) 231-1772 Time/Date Set: Sample Type (circle one): 1. Potable 2. Non Potable Time/Date Collected: Collected By:_ 0/2 Collected From: Location's/Individual's Name Street City/St/Zip Identification of Source Collection Point 3. Non Potable Treated 4. Other 1/31/62 Agency Code: NENC Field Blank Bottle #'s: 11007 Chain of Custody? Yes _ Comments: PWS #:. Bill to: Name/Company Street City/St/Zip Phone#: -No Source ID: FOW CA,CH, BI? BACTERIOLOGICAL ANALYSIS Lab#: Lab#: Heterotrophic Plate Count (hemodialysis & all others) Coliform P/A (Public supplies) Coliform MPN (priv well, raw, stp) Fecal Coliform (all samples) Microscopic Macroscopic API Other: Refrigerated? Chlorinated:? Free Chlorine Res: Total Chlorine Res: pH - yes _ no yes no -mg/L mg/L ORGANIC POTABLE ANALYSI -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) Other Pesticides (SM18/6630) UCMR List 1 MtBE Only (524) RADIOCHEMICAL ANALYSIS Radon Other INORGANIC ANALYSIS REQUESTED - Lab#: Color - Acidity Turbidity Alkalinity Bromide Conductivity Bromate/Chlorate/Chlorite Corrosivity (temp: °C) Chloride BOD (5 day) Cyanide Carbonaceous BOD (5 day) Fluoride Soluble BOD (5 day) Hardness, Total as CaCO3 Chemical Oxygen Demand Nitrogen, Ammonia as N Dissolved Oxygen Nitrogen, Nitrate as N Total Organic Carbon Nitrogen, Nitrite as N Total Organic Halides Nitrogen, Total Kjeldahl as N Solids, Percent (%) Oil and Grease Solids, Settleable Phenol Solids, Suspended Phosphorus Total as P Solids, Total Phosphorus, Ortho as P Solids, Total Dissolved Sulfates Solids, Total Volatile Surfactants Other: UV254 Aluminum Antimony Arsenic Barium Beryllium Boron Cadmium .Calcium, as CaCO3 Calcium, Ca*2 Chromium, Total Chromium, Hexavalent Cobalt Copper Iron Lead Magnesium Manganese Mercury Molybdenum Nickel NYC-WTC_000073234 Q 837 nelac NYS-ELAP No. 10108 Form A-70 (rev. 10/01) Type Descriptor: Fax#: Check#: Amount$ '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 HydrocarbonScan (310-13) Glycols in Water Acid Extractables (625/8270) Base Neutral Extractables (625/8270) -GC/MS Unknown Scan Phthalates (606MS) Other: Potassium Selenium Silver Sodium Thallium Vanadium Zinc CLP Metals/CN Volatiles Semi-violatiles Pesticides/PCB's TCLP TCLP-Metals TCLP Pesticides TCLP-Herbicides TCLP-Volatiles TCLP BNAS