Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document , ...An •

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

Time/Date Set: ster com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 smandt NYS-ELAP No. 10108 09 Form A-70 (rev.1/96)

sample Type (circle one): (1Potable 3. Non Potable Treated Bottle #s: _ 9057 30050 2. Non Potable 4. Other __________ Chain of Custody? yes no Time/Date Collected: 9-/S-2/ A72 Comments: Collected By: _ VAs Agency Code: _ Source ID: Type Descripton Collected From: Bill to: Location’s/ndividual’s Name A - Name/Company _ Street______________ SA22EC Street________ City/St/Zip_____ ;_____ City/St/Zip_____ Identification of Source _ Phone#: ______ Fax Collection Point - ... .. $/762000■ ■■ ------------- = — CA.CH, ■ Bl? _ __ Check#: Amounts. ** r ? ■ ■ ================================================================;=== BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS 8. IGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_________ ' Lab#: (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) / C 4. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2. Volatile Halocarbons (524) * 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) 3. Volatile Aromatics (524) V _ 3. Acrolein & Acrylonitrile (624) le 2 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) - J 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) *..2 6. Macroscopic 47) Pesticldes/PCB screen (508) 7. Methoprene (616) 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) ten 9. Herbicides (515) 9. Pesticides (SM18/6630) > Refrigerated? yes no c10 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13). 11. Carbamate Pesticides (531) 11. Glycols ** Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 22 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticldes/PCB’s (DEF) 18. Other_______________________ 18. Other___________ .________ ___

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium K 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver; 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 44. Boron 63. Thallium 6. BOD (5 day) 25. Cyanide 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc . 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 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. Semi-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 53.Lead TCLP (Sollids. Suspended 34. Phosphorus Total as P 71 .TCLP-Metals “Sollids. Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-Pestlcides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73.TCLP-Herbicides 37. Surfactants 56. Mercury 18. Solids, Total Volatile . 19. Other___________ 38. UV254 57 Molybdenum 74. TCLP-Volatiles 75. TCLP-BNA’s 58. Nickel od .. _ _ NYC-WTC_000025880