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Chain of custody record, Westchester County Department of Labs &

Machine-extracted title · confidence 95%

Form documenting the chain of custody for samples submitted to or received from the Westchester County laboratory.

NYC-WTC_000074972–000074977

Folder label: “AE 05700

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Scanned page image, NYC-WTC_000074974
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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 Timo/Date Set: Sample Type (crcle one): Potable 3. Non Potable Treated 2a von Potable 4. Other _ Ime/Date Collected Collected By: . Lab Collected From: Location's/Individual's Name Street .City/StZip Identification of Source Collection Point 02 Agency Code:NeNE Field Blank nebct NYS-ELAP No. 10108 Form A-70 (rev 10/01) Bottle #'s: P 1610,02894 Chain of Custody?. iiYos. _ No Comments: PWS #:. Source ID: _Type Descriptor:: Blll to: Name/Company Street City/St/Zip Phone#: Fax#: Fblu CA,CH, BI? - :Check#: Amounts BACTERIOLOGICAL ANALYSIS Lab#: Heterotrophic Plate Count (hemodialysis & all others) Coliform PIA (Public supplies) Coliform MPN (priv well, raw, stp) L Fecal Coliform (all samples) a Microscopic - мacroscopic 2 APFC ¿Other: Refrigerated? - -yes _ nO Chiorinated:?_ yes —no Free Chiorine Res: _mg/L Total Chiorine Res: _mg/L Lab#: ORGANIC POTABLE ANALYSÍS _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) ORGANIC NONPOTABLE/ SÓLID ANALYSIS Purgeable Halocarbons (624/8260) -Purgeable Aromatics (624/8260) Acroleln & 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 Acid Extractables (625/8270) Base Neutral Extractables. (625/8270) XGC/MS Unknown Scan Phthalates (606MS) Other: RADIOCHEMICAL ANALYSIS Radon Other INORGANIC ANALYSIS REQUESTED - Lab#: Color - Acidity Turbidity - 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 (%) 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 CaCOs Calcium, Cat? Chromium, Total Chromium, Hexavalent Cobalt Copper Iron Lead Magnesium Manganese Mercury Molybdenum Nickel - Potasslumi _ Selenium : Sliver : Sodlum - Thallium Vanadium Zinc CLP Metals/CN _Volatiles ,Semi-violatiles ,Pesticides/PCB's ICLP _TCLP-Motals _ TCLP-Pesticides TCLP-Herbicides : TCLP-Volatiles ,TCLP-BNAs NYC-WTC_000074974

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NYC-WTC_000074974Source: NYC Law Department, mirrored locally

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NYC-WTC_000074851 · Box DEP Box 62

Chain of custody documentation for environmental samples transferred to the Westchester County Department of Labs and Research in Valhalla.

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