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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 44 ‘*orn**=*4.** .

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH iv.com 15 2 Dana Road, Valhalla, New York 10595 9 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96)

pleType (circle one): CPotable 3. Non Potable Treated Bottle #‘s: -500/ 30,262 2. Non Potable 4. Other___________ Chain of Custody? les no Time/Date Collected: 7- /sa/ /24% Comments: Collected By: _ Agency Code: PWS# Source ID: .Type Descriptor: Collected From: • Bill to: Location's/Individual’s Name. AA-S/EC/L _ 1 Name/Company_ Street TS/MPS Street City/St/Zip___________________ :_ City/St/ZIp Identification of Source __ ________________ __________ Phone#: ■ - Fax# Collection Point $ie 30252 =CACH,Br* . • .*. * ,-Bheda**] Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#:_____________________ ORGANIC POTABLE Lab#: ANALYSIS 0 ■ eryi RGANIC NONPOTABLE/SOLID ANALYSIS (circle teste) (circle tests) : 1. Heterotrophic Plate 1. Trihalomethanes (524). 1.Purgeable Halocarbons (624/8260) Count (hemodialysis & aD others) 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, 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 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic ZPesticides/PCB screen (508) 7. Methoprene (616) 2) 7, API y aer 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 8. Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630) Refrigerated? yes no a0 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) _ 11. Carbamate Pesticides (531) 11. Glycols r. Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) 33 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. Pesticides/PCB’s (DEF) 18. Other:_______________________ 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 O - 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium | « co - 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 63. Thallium] "C === 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium t 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc :• 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 NI 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 TCLP 1sollids. Suspended 34. Phosphorus Total as P 53.Lead 71 TCLP-Metals . Nollids. 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 58. Mercury 202 38. UV254 57 Molybdenum 74. TCLP-Volatiles .19. Other:___________ 75.TCLP-BNA’s . 58. Nickel n asze daztet NYC-WTC_000025882

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