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Chain of custody form, NYC DEP sample AE04843, Feb 2002

Machine-extracted title · confidence 95%

Documentation recording the transfer and handling of a water sample submitted to Westchester County Department of Labs.

NYC-WTC_000074572–000074580

Folder label: “AE 04843

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Scanned page image, NYC-WTC_000074575
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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) 231-1772 Time/Date Set: Sample Type (circie one): 9- Potable 3. Non Potable Treated 2. Non Potable 4. Other _ Time/Date Collected: Collected By: - IfcTr Collected From: Location's/Individual's Name 06519 Street City/StZip Identification of Source Collection Point _ 1E3r0 a55 H:30a ?17/2 Agency Code: Botte #s0271 243T 2437 Chain of custody? - res- - No Comments:. PWS #: _ Source ID: . Bill to: Name/Company Street. City/St/Zip Phone#:_ CA,СН, ВІ? . 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? -yes Chlorinated:? — yes _ no Frée Chlorine Res: Total Chlorine Res: _ - по _mg/L _ mg/L pH RADIOCHEMICAL ANALYSIS Radon :Other 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) _Other Pesticides (SM18/6630) _UCMR List 1 "tà: _ MtBE Only (524) INORGANIC ANALYSIS REQUESTED - Lab#: Color -Acidity Turbidity -i Alkalinity pH - 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 (%) -SOll and St Solids; Settleable _ Phenol Sollds, Suspended - Phosphorus Total as P Solids, Total Phosphorus, Ortho as P Solids, Total Dissolved Sulfates Sther, Toal Volatile Surfactants Other: _ UV254 048118 _Atuminum Antimony Arsenic ww Barium Beryllium :Boron Cadmium Calcium, as CaCO3 Calcium, Ca*? eeChromium, Total Chromium, Hexavaient *Cobalt _Copper wiron Lead - Magnesium Manganese Mercury L'Molybdenum →Nickel NYC-WTC_000074575 ITED 3 ne NYS-ELAP No. 10108 Form A-70 (rev. 10/01) P 207 0107 Type Descriptor: _Fax#: - Check#: Amount$ ORGANIC NONPOTABLE/SOLID ANALYSIS Purgeable Halocarbons (624/8260) Purgeable Aromatics (624/8260) :Acrolein & Acrylonltrile (8260) Organochlorine Pesticides (608/8081) PCBs (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) Lz GC/MS Unknown Scan Phthalates (606MS) ,Other: Potassium Selenlum Silver i Sodium *Thaillum - Vanadium Zinc _Metals/CN Volatiles - _ Semi-violatiles Pesticides/PCB's ICLP _TCLP-Metals —TCLP-Pesticides . TCLP-Herbicides -TCLP-Volatiles TCLP-BNAS

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NYC-WTC_000074575Source: NYC Law Department, mirrored locally

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