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Chain of custody form, Westchester County Lab, Sep 2001

Machine-extracted title · confidence 95%

Record documenting the chain of custody for samples submitted to the Westchester County Department of Labs & Research in Valhalla.

NYC-WTC_000025692–000025696

Folder label: “22470 - 22496

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NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM wr SI CHLSTFR COUN I Y I ABC 335 QHES AND KE ; AicH

—CAs45 2 Dana Road, Valhalla, New York 10595 ‘ 11 lestchester County (914) 593-5575 Ps L/ln NYS-ELAP No. 10108

40 Sample Type (circle one): ' sp ■ e x 46* 2- ■ aft c thdsese)/l 2 9041/22, ■ \ Form A-70 (rev. 1/96)

*** mGOLGtOUi ‘22 >2* ' ■ (Es > 0 (1. Potable) 1 3. Non-Potable Treated " Bottle #‘s9-.99. /4477242400275320 n NPotatiic 4. Other___________ Chain of Custody? '___ yes_____ no 95,

Time/Dale Collected: Collected By -al 1-10O 3/61— Agency Code:.... Comments:_____ PWS #:..... ... _...... Source ID: _ Type Descriptor Collected From: Bill to 7 Location’s/Individual’s Name C ■ A --------- ------------ — Name/Company_ ___ _______ Street_5t_ s____ _e < „ _ . ’ ■ f "ni ■: — •—---------- f"....... u " ......... ..... ... .... T Street 1 111 --===--=======——...... .....—- --- ——-

City/SUZipA/EAttkss__ KU.J. _ Identification of Source___ 2. - City/StZip—--- Fax# - , Phoneff Collection Point&s 1... _L it (4 J CA, CH. BI?.... Check#:........ .. Amount?

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTARLF/SOI ID ANAI YSFS

Labk_g Lab □ 7 ph/ 2. (cicle tests) gircle tests) ----- 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260), Count (hemodialysis & all others) 2) Volatile Halocarbons (524) 2 Purgeable Aromatics (624/8260) / 2. Coliform P/A (public supplies) 3.7 Volatile Aromatics (524) / 3. Acrolein & Acrylonitrile (624) ! 3. Coliform MPN (priv well, raw, stp) 4. Total Trhalomethane Potential (510) 4. Phthalates (606/8060) | 4. Fecal Coliform (all samples) (5. Microextractables (504) -5. Organochlorine Pesticides (608/8080) | 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 1Z.Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) I 6. Macroscopic IAPIr 8. PCB as Decachlorobiphenyl (508A) 29? Herbicides (515) 8.' Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) . Ger_ ___ ___ -10 Pesticides (525) 10. Glycols in Water i ' 2 Refrigerated?y e s _......... no (11? Carbamate Pesticides (531) 11. Acid Extractables (625/8270) Li2:‘Glyphosate (5 4 7) 12. Base Neutral Extractables (625/8270) Chionnated?: _____ yes.............. no < 213? Diquat (549) 13. GC/MS Unknown Scan . 14. Chlonnation Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:_________ mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-1 8/6630) 16 Pesticides (DEF) ' 3 1 Tutal Cn'onne Res: . .. 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

L D' £%2, /i/s INORGANIC ANALYSES REQUESTED - Lab#:. ... (circle tests) MN CsRoeeq (39, Aluminum __ 1. Color 20. Acidity / 59. Potassium 2. Turbidity//go 21. Alkalinity, as CaCOi 40.. Antimony 601 Selenium 3_H i 4. Conductivity 22. Bromide 23. Bromate.’Chlorate/Chlorite 41J Arsenic ■ 42.Banum 61 Silver 62. Sodium i 5 Corrosivity (temp:______ °C) C ROD (5 day) 24. Chloride 25. Cyanide 44. Boron 43, Beryllium a 63. Thallium \ 64. Vanadium 7 Soluble BOD (5 day) 26. Fluoride 27. Hardness, Total as CaCQ3 46. Calcium, as CaCOa 1(45) Cadmium m \65/Zinc______ CLP 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N (47 Calcium, Ca" 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N ' (48: Chromium, Total 67. Volatiles 11. Total Organic Carbon • 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent G8 Susi volitil - 12. Total Organic Halides . 31. Nitrogen, Total Kjeldahl as N /50. Cobalt ns i "aheklizr 'Pt :5 ) ’ 3. Solids, Percent (%) A ggolids. Settleable 32. Oil and Grease 33 Phenol - f 51: Copper 52.on----- ,53.Lead" 70. Disk Deliverables TCLP

7-16. Solids. Total cat 36. Sulfates — 34. Phosphorus, Total as P 35. Phosphorus, Ortho as P 55.Manganese 54 Maqnasium 71. TCLP-Metals 72.TCLP. Pesticides

118. Solids.AEECASI Total Volatile — 37.38.UV254m 17. Solids. Total Dissolved

19. Other: Surfactants_ 56.Mercuryr 57. Molybdenum o 73. TCLP-Herbicides 74. TCLP-Volatiles ' 75. TCLP-BNA’s 158/Nickelss NYC-WTC_000025693

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NYC-WTC_000025693Source: NYC Law Department, mirrored locally

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