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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 ster vcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 © NYS-ELAP No. 10108 ge/Date Set: Form A-70 (rev.1/96)

Sample Type (circle one): 6/0(,0003,8S$1 @s*0 6549(654 GPotable 3. Non Potable Treated Bottle #s: 993/ 1364, +80 2 760, 0302- 2. Non Potable 4. Other —__________________ — Chain of Custody? yes no Time/Date Collected: 2/21 1^60/ MS5 Comments: Collected By: P, Gevtsil . Agency Code: _ Source ID: .Type Descriptor: Collected From: P Bill to: Location's/ndividual's Name 0 _ ________________ Name/Company Street ___ ____________________________________ Street________ City/StZip______________________________________ _ Identification of Source_____ _________________ Phone#:______ Fax#: Collection Point _________________________________ CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________________ Lab#:________ _ (circle tests) (circle tests) C . 1. Heterotrophic Plate 1.Trihalomethanes (524) 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. PCB’s (Arochlors) (608/8081) 6, Macroscopic 2 ,6.1Pesticides (507) Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) 7. Methoprene (616) 8. Herbicides (EPA1978/8151)

6 Brothen_________________ Herbicides (515) 9. Pesticides (SM18/6630) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Befrigerated? yes no 11. Carbamate Pesticides (531) . . 11. Glycols 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) C 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other._______________________ . 18. Other ____________________ -S 1m — INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) y 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium C 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chiorate/Chlorite 42. Barium 62. Sodium S 5. Corrosivity (temp:. °C) 24. Chloride 43. Beryllium 44. Boron 63. Thallium so 6. BOD (5 day) 25. Cyanide 64. Vanadium C 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 R 11. Total Organic Carbon 12. Total Organic Halides 13. Solids, Percent (%) 30. Nitrogen, Nitrite as N 31. Nitrogen, Total Kjeldahl as N 32. Oil an Grease 49. Chromium, Hexavalent 50.Cobalt 51. Copper 68.Semi-violatiles 69. Pesticides/PCB’s 70. Disk Deliverables + . Solids, Settleable 33. Phenol 52. Iron TCLP . Solids, 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 57 Molybdenum 74. TCLP-Volatiles 19. Other:___________ 38. UV254 75. TCXP-BNA’s 58. Nickel

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