Chain of Custody Record, Westchester County Dept of Labs

NYC 9/11 Public Portal Document Westchester gov.com ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORMI WESTCHESTER COUNTY LABORAȚORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595: (914) 231÷1620 Fax (914) 231-1772: ACCOAK Time/Date Set: NYS-ELAP.No: 10108 Form A-70 (rev.10/01) Sample Type (crcle one): r1. Potable 3: Non Potable Treated 2: Non Potable 4. Other: Time/Date Collected: - '830 Collected By: Ê.. "urao =/4/0z Agency Code:: Collected From: Location's/Individual's Name41!C DéP Street _ 14.11). LAKE Dr. City/StZip Datballa 10545 Identification of Source Collection Point — •Del IE UUA 2561,756l Bottle #'s: Chain of Custody?:__ Yes: Cömments:_ PW$#: Bill to: Name/Company Street City/St/Zip Phone#: p-z74=72c Sourcẻ ID: _Type Descriptor: : Fax#: CA,CH, BI?- Chečk#: • Amounts. BACTERIOLOGICAL ANALYSIS 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:? *Xyes Free Chlorine Res: Total Chlorine Res: no no mg/L, _mg/L pH Lab#: ORGANIC POTABLE ANALYSIS - Trihalomethanes (524) 1Volatile Halocarbons (524) Volatile Aromatics (524) Total Trihalomethane Potential' (510) Microextractables (504) Pesticides/PCB screen (508) PCB'as Decachlorobipheny! (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 -MIBE Only (524) ORGANIC NONPOTABLE/SOLID ANALYSIŞ .- Purgeable Halocarbons . (624/8260) _ Purgeable Aromatics (624/8260) -Acrolein d Acrylonitrile (8260): - Organochlorine Pesticides (608/8081)!: s- PCB'S (Arochlors) (608/8081) -Herbicides (SM18/6630,8151)! _ Other Pesticides (SM18/6630) "Petroleum Hydrocarbon Scần (310-13)! * - Glycols in Water Acid Extractables (625/8270)" Base Neutral Extractables (625/8270).. L.GC/MS Unknown Scan, = Phthalates (606MS) - Other: RADIOCHEMICĄL ANALYSIS Rädốn Other_ INORGANIC ANALYSIS REQUESTED - Lab#: _ Color:. - Turbidity, pH Conductivity Corrosivity (temp:_ _°C) BOD (5 day) Carbonaceous BOD ,(5 day). - 'Soluble BOD (5 day) ---Chemical Oxygên Demand -. Dissolved Oxygen' Total.Organic Carbon Tötal'Organic "Halides Solids, Percent, (%). _Solids, Settleable Solids, Suspended Solids, Total: Solids; Totãl Dissolved' - Solids, Total Volatile Other: Acidity. Alkalinity Břomide Bromäte/Chlorate/Chiorite Chloride Cyanide Fluoride: Haïdness; Total as CaCO3 Nitrogen, Ammonia as N Nitrogen; Nitrate as N: Nitrogen, Nitrite as N _ Nitrogen; Total Kjeldahl as N.. Oiliand Grease: Pheno!! = Phosphorus:Total.as.P) Phosphorus; Ortho as'P* Sülfates; Sürfactants UV254' Aluminum 2Antimony Arsenic *Barium LBeryllium: Boron &Cadmium = Calcium, as CaCO3: Calcium; Ca+2 *Chromium, Total Chromium: Hexavalenti «Cobalt Copper, Lelron) 1Lead. • Magnesium" i Manganese: -Mercury .Molybdenum: Nickel! ...Potassium Selenium Silver, Sodium Thalium vanadium 2Zinc CLP Metals/CN. Еботмоанибв, 1Pesticides/PCB'S ICLP ¡→ ICLP-Metals: TCLp'Pesticides) →TCUP Herbicides: TCLP: Volatiles. TELPBNAS* NYC-WTC_000073329