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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 com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96) sMpie Type (circle one): Ss9, 8S0,000,159.*78 CPotable 3. Non Potable Treated Bottle #‘s: 987 4 8SS 7, SsSY, 8ss6 886 / 2. Non Potable 4. Other __ ____________________ Chain of Custody? yes no Time/Date Collected: Q/2//200/ 1030 Comments: Collected By: S, 4hwad Agency Code: PWS#:_______ Source ID: .Type Descriptor Collected From: Bill to: Location's/Individual’s Name _ VYh________ Name/Company Street___________ :____________________________ Street________ City/St/Zip____________________________________ _ Identification of Source___________________________ Phone#:______ Fax#: Collection Point_ 33450 CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_____________________ (circle tests) 1. Heterotrophic Plate (cirole tests) 2332 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) C2, 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 i 7Pesticides/PCB screen (508) 7. Methoprene (616) 7. 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) _________________________ 9. Herbicides (515) 9. Pesticides (SM18/6630) (10. Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 12. Add 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) 7? pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF) 18. Other_______________________ 18. Other_____ __________________ X. INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity 3. pH 20. Acidity 21. Alkalinity, as CaCOa 22. Bromide salaumanimydluk 40. Antimony 41. Arsenic 59. Potassium 60. Selenium 61. Silver S

E 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 C. I 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs CLP : 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca+Z 66.Metals/CN oi C. ; io. 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 N 50.Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51.Copper 70. Disk Deliverables 14. Solids, Settleable 10plids, Suspended 16. Solids, Total 33. Phenol 34. Phosphorus Total as P 35. Phosphorus, Ortho as P 52. Iron 53.Lead 54 Magnesium TCLP 71 .TCLP-Metals §3 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 58. Nickel 75.TCLP-BNA‘s

NYC-WTC_000026437

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