Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

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HI ENVIRONMENTAL SCNVICES SAMPLE SUBMISSION FORM WrSTGHLSTER COUNTY 1. ABORATORILS AND ne St ARCH

‘do**(nster uty 112 Dana Road,9Val14hal593-557 York 10595 a, New5 4 NYS-ELAP No. 10108 g ple type . • ’ ’ ) 27A 0-2613,0F02693,G-00‘e IotA-7 ( 8-2261 y/-“%/yi

d. Potable). 3. Non-Potable Treated 2. Non-Potable .4. Other __ Bottle #‘s: PitH Chain of Custody? yes 0*370 no PrA5u6/#e

Time/Date Collected: nets /_ _____ ■ Comments;________ Collected By: Aj 6, * A) ANTA t, Agency Code:___ ... PWS #_ ___________ Source ID: Type Descriptor: Collected From: . CBIIIto Lenatinn‘allnded"o"s Name AA *f P Name/Company___ Street Ml_ toetilke_ D&..... . ____ Street N Cry/SZip_YeLee IA ‘ 1 / ′ > 2____ City/StZip Identification of Source_______________ ______ __ ______ Phone#.. —Fax#: Collection Point._ ( ____ le t _ _ J. CA. CH. BP Check#;__ ._ . Amounts

«Rli LoCCAi ANALYb s i ORGANIC POTABLE ANALYSES ( i C NONYOrABLE -SOLIil ANAI. YSi 5 Lab#:______________________ ' Lab #:_____ _______ _ _____________ (circle tests) icircle tests) MAeb 1. Heterotrophic Plate : 1.Trhalomethanes (524) . 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 1.2,. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) [3. Volatile Aromatics (524) 3 Acrolein & Acrylonitrile (624) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) 4. Total Trhalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (-all samples) . 5.Microextractables(504) 5. Organochlorine Pesticides (608/8080) • i 7/6. PCB’s (Arochlors) (608/8080) 5. Microscopic . . . ‘esticides (507) 6. Macroscopic ’ . esticides/PCB screen (508) * Herbicides (SM-1 8/6640; 8151) LAPM 8. PCB as Decachlorobiphenyl (508A) 8. .Other Pesticides (SM-18/6630) LOther /10. Pesticides (525) 9. Herbicides (515) . ma - —9. Petroleum Hydrocarbon Scan (310-13) ■ .10. Glycols in Water Refrigerated?_____ yes_____ no 11. Carbamate Pesticides (531) ‘ 11 1. Acid Extractables (625/8270) 12. Glyphosate (547) . 12. Base Neutral Extractables (625/8270). Chlorinated’’: yes no 13, Diquat (549) 13. GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) 14. Chlorination Disinfection Byproducts (551)i Free Chlorine Res; ___ _ lb. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF)

Total Chlorine Res: _mg/L 16. Other Pesticides (SM-18/6630) 17. Petroleum/Hydrocarbon Scan (310-13) 16. Pesticides (DEF) e 17. PCB’s (Arochlors) (DEF)

pl. a INORGANIC ANALYSES REQUESTED - Lab#: (circle tests)—al ).2 (.1 ing A ! 1. Colore 20. Acidity (391 Aluminum s * - m Turbidity 2.3H Men 21. Alkalinity, as CaCOa 22. Bromide 40. Antimony 41 (Arsenic rem. 61. Silver■" 60. Selenium,

4. Conductivity 23. Bromate/Chlorate/Chilorite 42. Barium 62. Sodium ; 5 Corrosivity (temp: _____ °C) ) 24. Chloride 43/ Beryllium : thallar / C. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium g ■ 7. Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 26. Fluoride - 27. Hardness, Total as CaCO, I (45. Cadmium n 46. Calcium, as CaCOa 65, Zinc________ I CLP_a 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*2 . 66. Metals/CN . 10. Dissolved Oxygen 11. Total Organic Carbon 29. Nitrogen, Nitrate as N 30. Nitrogen, Nitrite as N 48. Chromium, Total 49. Chromium, Hexavalent 67. Volatiles sr S > val Y i 50 Cobalt 12. Total Organic Halides 13. Solids, Percent (%) ..32. 33. 011 and Grease ive 5251 Iron 31. Nitrogen, Total Kjeldahl as N

Phenol "herte Copper A ;■ 1. Perut.nide : 1 ‘CH s 70. Disk Deliverables TCLPAIR Solds, Settleable Solids. Suspended ' "34. Phosphorus, Total as P.s 53.54.Magnesium Lead 71.TCLP-Metals 72.TCLP-Pesticides Solids, Total .

Solids, Total 18.19. Other Vol a ti l e as 13 6. Sulfates s 55,56, Manganese 35. Phosphorus, Ortho as P .ml 75.74.TTCLP-BNA CLP-Volatiles 73. TCLP-Herbicides 17. Solids, Total Dissolved

Sotyt I38.UV254. M37.Surfactantsa Mercurvalensita ‘ss 57. Molybdenum ‘ 158 Nickelses Ls anaites 1 NYC-WTC_000026520