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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_000026432–000026446

Folder label: “23318

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NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Ulestchester County (914) 593-5575 NYS-ELAPNo. 10108 Time/DateSet:_____ __________________________________ Form A-70 (rev. 1/96) Subiple Type (circle one): 860 1 F6Q , 6s4b , 6672-.PF6 8678, 8632 1,Potable 3. Non-Potable Treated Bottle #s:8oSS, 0403,60S 2,0030 2. Non-Potable 4. Other , _______ __ __________ Chain of Custody? yes .no Time/Date Collected: 9/22/200/ _ qAn— Comments: Collected By:. M-YACouR_ _Agency Code: PWS #:_________ Source ID: Type Descriptor: Collected From: • Bill to: Location's/individual's Name_ Hallview) Name/Company Street ........................ ........................................... .......... ......... Street__________ City/St/Zip ________________________________ City/St/Zip_______ Identification of Source,_____________________________ ____ Phone#:_ Fax#:, Collection Point, 8158 _________ CA, CH, BI? Check#: Amounts,

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: (circle tests) _________________ lab.: ---- 92210 (circle tests) . I I 1. Heterotrophic Plate Trihalomethanes (524) I 1. Purgeable Halocarbons (624/8260) - Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. PCB*s (Arochlors) (608/8080) 6. Macroscopic C 7.Pesticides/PCB screen (508) 7. Herbicides (SM-1 8/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8ther: 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) ( 10. Pesticides (525) 10. Glycols in Water Refrigerated? yes____ no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlonnated?: ves_____ no 13. Diquat (549) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chiorine Res:. mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) O C Total Chlorine Res: mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

pH INORGANIC ANALYSES REQUESTED - Lab# S (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium e 2. Turbidity 3. pH 21. Alkalinity, as CaCOs 22. Bromide 40. Antimony 41. Arsenic 60. Selenium 61. Silver o 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: .°C) 24. Chloride 43. Beryllium 63. Thallium Cw 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc__________ S G- 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10. Dissolved Oxygen 27. Hardness, Total as CaCOs 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N 46. Calcium, as CaCOs 47. Calcium, Ca*2 48. Chromium, Total CLP 66. Metals/CN 67. Volatiles I 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatiles 0 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14Solids, Settleable 33. Phenol 52. Iron ISLE Colids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. 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. Molybdenum 75. TCLP-BNA’s AS = 58. Nickel

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