Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

ULH — ' ENVIRONMENTAL services SAMPLE SUBMISSION FORM - yySxeg Nco.: WESTCHESTER COUNTY LABORATORIES AND RESEARCH —P ■ 2 Dana Road, Valhalla, New York 10595 914) 593-5575 AP No, 10108 .Ptr ; .** e/FoNrmS-ELA-70(rev.1/96) Sample Type (circle one): —n#*7#6#65o3B0H0Cgas 87 133, 24/ /6, (/5, *6/ : I• ort alrbslo heated Bottle #‘s:___E__ -----====== r__________ . ) 2. Nori Potable - ! b Chain of Custody?___ yes _.... no Time/Date Collected:__ ( * ‘2 & Collected By: 62" 0< 671 2/1/0/ Agency Code: ■ Comments:________ PWS#_ > . : j * »ia ‘ *"a p ~r, Collected From: Bill to: — Location’s/Individual’s Name.. _ HI Name/Company Street _ . ___ -YC Street C ity/St/Zi p _ mia___ L 7ha(l 4//02 City/St/Zip_________ Identification of Source__ wlllili Phonefm . Fax#:__ Collection Point 7. •• / t P CA,CH,BI?_ i.s Amounts__

BACTERIOLOGICAL ANALYSIS CHeANit PC । BBi.L AMYSs ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:__________ _____________ _ Lab# Tei (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ("2 Volatile Halocarbons (524) ! e Arom’i ai* 0 2. Coliform P/A (public supplies) 3) Volatile Aromatics (524) 3. Coliform MPN (priv well, raw, stp) 4. Fecal Coliform (all samples) 4. Total Trihalomethane Potential (510) 5. Microextractables (504) alates (625/8270) Grfor01: I -4, iPhthrlmoPedd 3. Acrolein & Acrylonitrile (624)

e. , Microscopic—Ig 0. Ho t; (on _ ( 7Pesticides/PCB screen (508) 8. PCB as Decachlorobipheny! (508A) • r. ; (Aporhoo) 7. Methoprene (616) : H ■ -irin (I TA1 nal; 119. Herbicides (515) Omaoe i . . .. . cnt/hn,au no TOPesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Me Chlorinated:? 11 Carbamate Pesticides (531) 12. Glyphosate (547) 11. Glycols 00] 12. Acid Extractables (625/8270)

Chlorine Res Ih. i 13, Diquat (549) = 13. Base Neutral Extractables (625/8270) ■14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan 6 Res: 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) ‘ Polick in am ‘o b Aromalce (01) 17. PetroleunuHiydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:___ -/ 18. Other: | INORGANIC ANALYSIS REQUESTED - Lab#:___ (circle tests) 1. Color 20. Acldily -Andal2 39. Aluminum ) 40..Antimony i Bommdi 2. Turbidity 3, pH 22. Bromide 21. Alkalinity, as CaCOa 7 142/Barium 7171/71/.61, Silver I ? 41. Arsenic (1 s

4. Conductivity 5. Corrosivity (temp:______ °C) 23. B rom ate/C h lo rate/Ch io rite 24, Chloride _ (43 Beryllium /162. Sodium _ — ■------- T 63. Thallium 6, BOD (5 day) A 25, Cyanide — 44. Boron | 64. Vanadium 7. Soluble BOD (5P day) U) 26, Fluoride ' 45. Cadmium 65. Zinc a h '. ■ e . i ■ (h 9. Chemical Oxygen Demand 7, J Mnass for.. so. 46. Calcium, as CaCOs 28 Nitroge • . A.te*s : : - " :47.Calcium, Ca*2 LCLP tits M* :A f | 2. Nitrogen fatipiio 1 I 48.Chromium, Total 10. Dissolved Oxygen /. volalif 1 , Total Oraanic Carbon 30. Niliogan, Nihil c N .50. 0 i f * . . 13 :..2 ': Ge Sli ojsbjot 12. Total Organic Halides olids. Per /of t 31. ANillog, Tat * N ii a .1 . w 52 Oil .Hi ( de i .. 151 CoConne balt-- r 2) ! ps nde i ‘ 0 ls l . • 1* "

33. Phenol t TCLP_ 31 hoxmas"—. : 1$ l 53.Lead / : ! Ci i M • i 3- Pn.x u.? । 54 Magnesium

56.55 Manganese ta i\ Volatile G sharaleni Mercury / it J P P ■ .!:■ ii>- ! 3. । C i>] -b P

119, Other » 37. sf 1 i 23. UN 7 too i"s* : | Ai aPvah ee 58. Nickel t i * 1(118

NYC-WTC_000025637