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Document / 5 pages

Chain of custody record, Sample AE04028, Feb 2002

Machine-extracted title · confidence 100%

Document tracking sample transfer to Westchester County Department of Labs and Research.

NYC-WTC_000074152–000074156

Folder label: “AE 04028

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Scanned page image, NYC-WTC_000074155
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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: nelac NYS-ELAP No. 10108 Form A-70 (rev.10/01) Sample Type (circle one): 1.Potable 3. Non Potable Treated 2. Non Potable 4. Other Time/Date Collected: Orso 2-17-02 Collected By: L. Wagne Agency Code: Collected From: Location's/Individual's Name NYC. DEP Street 19 WestLake Driut City/St/Zip Vainallo Ny 10s95 Identification of Source Collection Point De 112 P.982 P-1777 Q .567 Q-1280 Bottle #'s: C-1600 ктF И-385 л-386k 387 Chain of Custody? . Yes - Comments: PWS #: Source ID: Type Descriptor: Bill to: Name/Company Street City/St/Zip. Phone#: Fax#: CA,CH, BI? Check#: Amounts BACTERIOLOGICAL ANALYSIS Lab#: Lab#: Heterotrophic Plate Count (hemodialysis & all others) Coliform PIA (Public supplies) Coliform MPN (priv well, raw, stp) Fecal Coliform (all samples) Microscopic Macroscopic API Other: Refrigerated? Chlorinated:? Free Chlorine Res: Total Chlorine Res: рH -yes_ no - yes _ no - mg/L _mg/L ORGANIC POTABLE ANALYSIS Trihalomethanes(524) L 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) 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 AcidExtractables (625/8270) Base Neutral Extractables (625/8270) L/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 (%) Solids, Settleable Solids, Suspended Solids, Total Solids, Total Dissolved Solids, Total Volatile Other: Acidity Alkalinity Bromide Bromate/Chlorate/Chlorite Chloride Cyanide Fluoride Hardness, Total as CaCO3 Nitrogen, Ammonia as N Nitrogen, Nitrate as N Nitrogen, Nitrite as N Nitrogen, Total Kjeldahl as N Oil and Grease Phenol Phosphorus Total as P Phosphorus, Ortho as P Sulfates Surfactants UV254 LAluminum Antimony VArsenic Barium Beryllium Boron Cadmium Calcium, as CaCO3 Calcium, Ca*2 Chromium, Total Chromium, Hexavalent LCobalt Copper -Tron Lead _Magnesium Manganese LMercury c Molybdenum Nickel Potassium -Selenium • Silver Sodium eThallium Vanadium Zinc CLP Metals/CN Volatiles Semi-violatiles - Pesticides/PCB's TCLP TCLP-Metals TCLP-Pesticides TCLP-Herbicides TCLP-Volatiles TCLP-BNAS NYC-WTC_000074155

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NYC-WTC_000074155Source: NYC Law Department, mirrored locally

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NYC-WTC_000074243 · Box DEP Box 62

Documentation tracking the custody and transfer of environmental samples to the Westchester County Department of Labs and Research.

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