Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document Auss-***

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 “3 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96) SuRpieTypo (circle one): otable 3. Non Potable Treated ./S060 30/52 2. Non Potable 4. Other_______________________ Chain of Custody? yes no Time/Date Collected: _2~S-/./0 Comments: Collected By: VA//s Agency Code: PWS#:_______ Source ID: Type Descriptor. Collected From: Bill to: Location's/Individual's Name 4/-sHaL Name/Company Street___________________________________________ _ Street _ ______ City/St/Zip________ _ ______ _ _____________________ City/St/Zip _ __ . Identification of Source _________________________ _ ■ Phone#: _ Fax#: Collection Point _ 5/72 e/0 "2CA,CH,Bi" Check#: Amounts - . . ..* 11* . At 9.5.0

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS *W70ORGANICNONPOTABLE/SOLIDANALYSiS Lab#:____________________ Lab#:_________ ' /ml ■ _---- - 3 . (circle tests) (circle tests) " t , • 0 1. Heterotrophic Plate 1. Trihalomethanes (524) (g 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. 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 ( Pesticides/PCB screen (508) 7. Methoprene (616) Pi

8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) R Ker omer . Herbicides (515) 9. Pesticides (SM18/6630) Refrigerated? yes no 2 Pesticides (525) 11. Carbamate Pesticides (531) y? 10. Petroleum Hydrocarbon Scan (310-13) -s 11. Glycols f. 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 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 CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver . 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodiums 0 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. 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 (Solids, Suspended 34. Phosphorus Total as P 53.Lead 71 .TCLP-Metals ' TO. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 36. Sulfates 55 Manganese 72.TCLP-Pesticides 17. Solids, Total Dissolved 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 57 Molybdenum 74. TCLP-Volatiles ' 19. Other:________________ 38. UV254 75.TCLP-BNAS 58. Nickel — siohide NYC-WTC_000025883