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Chain of custody record, Westchester County Lab, Sep 2001

Machine-extracted title · confidence 95%

Document tracking sample transfer and custody for environmental testing at the Westchester County Department of Labs & Research.

NYC-WTC_000025875–000025889

Folder label: “22542 - 22558”

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NYC 9/11 Public Portal Document

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

(1 Potable 3. Non Potable Treated Bottle #‘s: -8002 2. Non Potable 4. Other __________________ Chain of Custody? yes no Time/Date Collected: 070/ /53 Comments: Collected By:. V/S _ Agency Code: PWS# Source ID: .Type Descriptor Collected From: Bill to: Location’s/Individual’s Name — -5/FcAf6 SAA lame/Comdanv Street________________ ___________________________ Street_____ _ City/St/Zip_________ ___ • . City/St/Zip _ Identification of Source _ .. . . • ... . Phone# _____—Fax—_______ ___ Collection Point .-/EScsC : — a : ——----- --------------------------- ------ • 1 ■ ■ . •* • . • ■ ' w . . ■ . UAlle Di 1' ■ 1 ■ ... ? ■ ** w Check#: Amounts BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS t ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:________ :______ Lab#: (circle tests) 1. Heterotrophic Plate Count (hemodialysis & all others) (circle tests) 1. Trihalomethanes (524) / _ 8 X

(2. Volatile Halocarbons (524) * s19 A. Purgeable Halocarbons (624/8260) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 3. Volatile Aromatics (524) \_ 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv wen, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic Pesticides (507) 6. PCB’s (Arochlors) (608/8081) .. 6. Macroscopic Pesticides/PCB screen (508) 7. Methoprene (616) 90 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 2 en Herbicides (515) 9. Pesticides (SM18/6630) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) _ Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Glycols 0 Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 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 (15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res: mg/L %* 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. _ ______________ ;___________ 18. Other__________________

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver S 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium ■ 5 =* 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 63. Thallium =d - 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium a 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc I 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCOs CLP i 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca+Z 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 (Solids, Suspended 34. Phosphorus Total as P 71 .TCLP-Metals > “Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles . 19. Other:________________ 38. UV254 57 Molyodenum 75.TCLP-BNA’S 58. Nickel

NYC-WTC_000025881

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