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Chain of custody form, Westchester County Lab, Sep 2001

Machine-extracted title · confidence 95%

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

NYC-WTC_000026351–000026358

Folder label: “23258

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NYC 9/11 Public Portal Document ‘ • -*** • *n—r/. ..

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 gate Set: 6 Form A-70 (rev. 1/96)

Sample Type (circle one): . 1 Potable 3. Non Potable Treated Bottle #s: c 9265 ??> r ? • 2. Non Potable 4. Other___________________ _ Chain of Custody? _ yes no Time/Date Collected: 4/0/ ______________ _ Comments: Collected By: F. bessous C eSAaency Code: PWS#:________ Source ID: .Type Descriptor: Collected From: Bill to: Location’s/Individual’s Name 0 9 Name/Company Street __________________________________ Street_________ City/St/Zip__________________________________ _ Citv/St/Zi Identification of Source ~S4 0*f 1A6 " Phone#: _ ______ Fax#: Collection Point____ 4 30 so/ 2359s CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#: Lab#:______________________ (circle tests) (circle tests) 1. Heterotrophic Plate 1.Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 22,olatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 2,3, Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (privwell, 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 ( 7.Pesticides/PCB screen (508) 7. Methoprene (616) _____________________ - 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 9. Herbicides (515) 9. Pesticides (SM18/6630) Refrigerated?. yes no ( 10) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) * 11. Carbamate Pesticides (531) 11. Glycols 4. 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) , , 45*. . 16. Purgeable Aromatics (DEF) pH ; 17. Petroleum/Hydrocarbon Scan (310-13) : 5 ■ 17, Pesticides/PCB’s (DEF) : 18. Other _.NA0de)N18Other_ ' ■ % ""pu" ! ", 11 19.i -

INORGANIC ANALYSIS REQUESTED - Lab#: 14 ■ ■ • " 9 .. 1. i. 220- (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 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+Z 66. Metais/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-violatlies 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 A Solids, Settleable 33. Phenol 52. Iron TCLP C Solids, Suspended 34. Phosphorus Total as P 53 .Lead 54 Magnesium 71 .TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73.TCLP-Herblcldes 18. Solids, Total Volatile 37. Surfactants 56. Mercury 38. UV254 57 Molybdenum 74. TCLP-Volatiles 19. Other:________________ 75.TCLP-BNAs 58. Nickel

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