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Chain of custody form, Westchester County Lab, Sep 2001

Machine-extracted title · confidence 95%

Document tracking the chain of custody for environmental samples submitted to the Westchester County Department of Labs & Research.

NYC-WTC_000026447–000026451

Folder label: “23318

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NYC 9/11 Public Portal Document 1p7p1—2091auun.onuop1a11==11==zx/===a===y==/==== UVMNWWH"AELNegeRygNM"ASSWUREIWWPPUT‘* PR N

MI Ulestchester County (e/DateSet____ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 , , . (858 ‘*l Form A-70 (rev. 1/96) NYS-ELAP No. 10.108

"T- Sample Type (circle one): 2623,6683,8639,8600 899 1. Potable 3. Non-Potable Treated Bomla#61,13‘S, 33,0920,005 1 8623 2. Non-Potable 4. Other. ________ —_________ Chain of Custody? yes .no Time/Date Colledted:@23/200/AM Comments: Collected By: M, YAco .Agency Code: PWS #: Source ID: .Type Descriptor: Collected From: *. n Bill to: Location’s/lndivlduars Name All lview) C se4vor r Name/Company Street________ _____ ____________________ ____________ Street Cny/SvZip_________ ______ Cry/SVZip Identification of Source’ - _____ Phone#_ Fax #:. Collection Point . . ■ 6158 .. i*, ...2 ... . CA, CH, BI?. Check#: Amounts.

BACTERIOLOGICAL ANALYSES i ORGANIC POTABLE ANALYSES . ORGANIC NONPOTABLE/SOLID ANALYSES Laba: - (circle tests). 205** — e: > 127 s. :.. 1. Heterotrophic Plate 40 • ? -*.2332.0 : : 1. jrihalomethanes (524) . - 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others)— . 2. Volatile Halocarbons (524) t" 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public Supplies). 32 Volatile Aromatics (524) ■ .3. Acrolein & Acrylonitrile (624) 4

3. Coliform MPN (prhr well, raw, stp) x 4. Total Trihalomethane Potential (510) 4. Phthalates (806/8060) 4. Fecal Coliform (all samples) : 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 2." • 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic cfpposticidosscgscreen (508) < 7. Herbicides (SM-18/6640; 8151) 8. PCB as Decachlorobiphenyl (SOSA) \ ‘ 8. Other Pesticides (SM-18/6630) 7. API her: 9, Herbicides (515) \I 9. Petroleum Hydrocarbon Scan (310-13) / ^Pesticides (525) ;; 10. Glycols in Water Refrigerated? ves no *' 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) ... 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chionnated?: ves l no 13. Diquat (549) “ 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) FreeChionne Res —ma/L15. Haloacetic Acids (552) V 15. Purgeable Aromatics (DEF) 16-Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: mg/L 1 7. Petroleum/Hydrocarbon Scan (310-13) 1-7. PCB’s (Arochlors) (DEF)

pH

INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) .._ - wb • 1. Color 20. Acidity 39. Aluminum ) 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 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 CaCOa 46. Calcium, as CaCOa 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-volatiles 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 olids. Settleable , 33. Phenol 52. Iron ISLE WS iolids. 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. UIV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel ................ - .................... .. * lud _____ . ... . . . -, • . NYC-WTC_000026449

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NYC-WTC_000026449Source: NYC Law Department, mirrored locally

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