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Document / 9 pages

Chain of custody record, Sample AE06449, March 2002

Machine-extracted title · confidence 95%

Westchester County Department of Labs and Research chain of custody form for a water sample.

NYC-WTC_000075364–000075372

Folder label: “AE 06449

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Scanned page image, NYC-WTC_000075372
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NYC 9/11 Public Portal Document Chester ov.com VENVIRONMENTAL SÉRVICES 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): dPotable* 3. Non Potable Treated 32 Non Potable 4. Other /Time/Date Collectec: 912 am Colleécted By. B. Gertsik Collected From: Locatton's/Individuat'e Nemea2 Street City/SUZip identification of Source Collection Point 44750 3/15/02 Agency Code: 08288 nehc NYS-ELAP No. 10108 Form A-70 (rev.10/01) Bottle #s: 0112, 3260, 3040, 423, 2162 Chain of Custody? * YeS _NO Comments: PWS #: Source ID: L Type Descriptor: Bill to: Name/Company ae Street City/St/Zip Phone#: Fax#: CA,CH, ВІ? Check#: Amount$ BACTERIOLOGICAL ANALYSIS Lab#: Lab#: Heterotrophic Plate Count (hemodlalysis & all others) Collform PIA (Publle supplles) Coliform MPN (priv well, raw, stp) Fecal Coliform (all samples) Microscopic Macroscopic APIR _ Other; Refrigerated? yes Chlorinated:? yes Free Chiorine Res: Total Chlorine Res: no no mg/L mg/L pH 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) Pesticldes (525) Carbamate Pesticides (531) Glyphosäte (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: Acid Extractables (625/8270) Base Neutral Extractables (625/8270) LGC/MS Unknown Scan Phthalates (606MS) "Other: RADIOCHEMICAL ANALYSIS Radon Other INORGANIC ANALYSIS REQUESTED - Lab#: _ Color Turbidity Conductlvity 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 Sollds, Total Solids, Total Dissolved Solids, Totel Volatile LOther: Acidity Alkalinity 1 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 Oll and Grease :Phenol Phosphorus Total as P Phosphorus, Ortho as P Sulfates Surfactants UV254 06454 Aluminum YAntimony Arsenic V Barium W Beryllium Boron Cadmium - Calcium, as CaCOs Calcium, Ca+2 EChromium, Total Chromium, Hexavalent kCobalt * Copper Liron KLead - Magnesium LManganese L Mercury * Molyiplenum w Nickel Potassium &Selenlum silver Sodlum Le Thallium Vanadium Izina a CLP _Metals/CN Volatiles Seml-violatiles Pesticldes/PCB's ICLP _TCLP-Metals TCLP-Pesticides - TCLP-Herbicides TCLP-Volatiles :TCLP-BNA's NYC-WTC_000075372

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NYC-WTC_000075372Source: NYC Law Department, mirrored locally

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Laboratory report detailing ICPMS analysis results for metals including antimony, arsenic, and barium in a water sample collected on March 16, 2002.

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Document recording the custody chain and handling details for samples submitted to the Westchester County Department of Labs and Research.

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