Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH com 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96) SRpietypo (circle one):

(Potable 3. Non Potable Treated Bottle *s . -30% /3sso 2. Non Potable 4. Other__________ Chain of Custody? 4 yes no Time/Date Collected: 2/S0/2%00 Comments: Collected By: VA S Agency Code: _ Source ID: .Type Descriptor: Collected From: Bill to: Location’s/individual’s NameM—5/64/L 5MAAL6C Name/Company Street________________________________________ ' Street_______ ___________________________ :_____________________ City/St/Zip____ Identification of Source T _____________ ____________ Phone#: Fax#: Collection Point 5/7a3osso___________ - CA,CH, B1? Check#: bacteriological Analysis Lab#:____________________ ORGANIC POTABLE ANALYSIS ______________________ ORGANCNONPOTAELE/SOUR'ANALY). (circle tests) (circle tests) . )) ' . *stend* ■ 1. Heterotrophic Plate (1.Trihalomethanes (524)A 1. Purgeable Halocarbons (624/8260). Count (hemodialysis & all others) (2. Volatile Halocarbons (524) -2. Purgeable Aromatics (624/8260) ' E 2. Coliform P/A (public supplies) (3.7 Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) W 3 Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential 10) 4. Phthalates (625/8270) .2* 4. Fecal Coliform (all samples) 5. Microextractabies (504) 5. Organochlorine Pesticides (608/8081) W 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) " 6. Macroscopic CZ.Pesticides/PCB screen (508) 7. Methoprene (616)

Gr— Refrigerated? yes no 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 70) Pesticides (525) 8. Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630) t

10. Petroleum Hydrocarbon Scan (310-13)2 11. Carbamate Pesticides (531) 11. Glycols 4. Chlorinated:? yes no 12. Glyphosate (547) 12. Add Extractabies (625/8270) 0 13. Diquat (549) 13. Base Neutral Extractabies (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L (5,Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:_______________________ 18. Other ru — INORGANIC ANALYSIS REQUESTED - Lab#: o3 (circle tests) — N 1. Color 20. Acidity 39. Aluminum 59. Potassium . •= 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium! 6 3. pH 22. Bromide 41. Arsenic 61. Silver T 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium ! 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 63. Thallium | 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca+2 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 68.Seml-violatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables 14, Solids, Settleable 33. Phenol 52. Iron (Folids, Suspended 34. Phosphorus Total as P 53.Lead TCLP 54 Magnesium 71 .TCLP-Metals * TOSolids, Total 35. Phosphorus. Ortho as P 55 Manganese 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 73.TCLP-Herblcides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 57 Molybdenum 74. TCLP-Volatiles ’ 19. Other:________________ 38. UV254 75.TCLP-BNAS 58. Nickel Azdiantdadaanaildazzikudunt h NYC-WTC_000025888