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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_000074576
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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 (circle one): 1Potable 3 Non Potable freated 3 Non Potable 4. Other Time/Date Collected: 12:21 prp 2/2т/с2 Collected By: * + Gertsie Agency Code: _ Collected From: Location's/Individual's Name 06503 Street. City/St/Zip Identification of Source _ Collection Point _ 38650 ne NYS-ELAP No. 10108 Form A-70 (rev. 10/01) Bottle #s: Ibс 1177. 2538,2247,077 Chain of Custody?. Yes No Comments: PWS #: _ Source ID: Type Descriptor: Bill to: Name/Company Street City/St/Zip. Phone#: Fax# CA,CH, BІ? .Check#: Amounts BACTERIOLOGICAL ANALYSIS 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 Ratrigerated? yes Chlorinated:? _ yes Free Chlorine Res: Total Chlorine Res:. ,по no _ mg/L _mg/L pH * RADIOCHEMICAL ANALYSIS Radon ) Other Lab#: ORGANIC POTABLE ANALYSIS Trihalomethanes (524) - Volatile Halocarbons (524) , Volatile Aromatics (524) Total Trihalomethane Potential Microextractables (504) Pesticldes/PCB screen (508) PCB as Decachloroblphenyl (508A) Herbicides (515) Pesticides (525) Carbamate Pesticides (531) Glyphosate (547) LDiquat (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) OtherPesticides (SM18/6630) Petroleum Hydrocarbon Scan (310-13) Glycols In Water _ Acid Extractables (625/8270) Base Noutral Extractables (625/8270) 7GC/MS Unknown Scan Phthalates (606MS) Other._ INORGANIC ANALYSIS REQUESTED - Lab#; _ Color Acidity :Turbidity pH _ Alkalinity Bromide Conductivity Bromate/Chlorate/Chiorite Corrosivity (temp:. 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 Sollds, Suspended Phosphorus Total as P Sollds, Total Phosphorus, Ortho as P Solids, Total Dissolved Sulfates IOther. Solids, Togr Yolatile Surfactants UV254 =04847 Aluminum :Antimony TrArsenic TBarlum VBerylllum ,Boron Cadmium Calcium, es CaCOs _Calcium, Catz ! Chromlum, Total Chromium, Hexavalent... ICobalt I copper Viron ELead Magnesium Manganese Y Mercury IMolybdenum k Nickel _ Potassium ESelenlum Silver Sodlum E Thalllung _ Vanadlum E znc CLP 2L Metals/CN - Voltiles -Semi-violatiles _Pestícldes/PCB's ICLP _TCLP-Metals _ TCLP-Pesticides _TCLP-Herbicides TCLP-Volatiles _ TCLP-BNA's NYC-WTC_000074576

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NYC-WTC_000074576Source: NYC Law Department, mirrored locally

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