Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNT Y LABORATORIES AND Rf1-? ARCH

4) 593-5575 NYS-ELAP No. 10108 —_ J >A e 28 Form A-70 (rev. 1/96) pi2w‘rrelespare-ous9,«-6yao.v-ov23. ime/Date Set' mn « fvpn ' •} 1. Potable) 3. Non-Potable Treated Bottle #s: G--610 Geeat,0A PPect___ 2. Non-Potable A Otha Chain of Custody?__ yes no Time/Date Collected: '^b^' 0.92.0 I Corementer Collected By: NF WMA4 /AAmr A t Agency Code:__ PWS #________ Source ID' Type Descriptor:

Collected From Location’s/Individual’s Name _0121 NYcDEP. BIllto= Name/Company suit 4- /.K Street City/St'Zip. V Ihol/c___ 19515 City/St/Zip.____ _____ Identification of Source_________ __ ____ _______ Phone#:_________ ___ Fax #: Collection Point D//& CA,CH BP Check#: Amounts

zntli ii* 1 OC45 ANALYM S () IGANIC (CI All : ANAI Y-A * 1,324. APLC NONPRNTARg 1 /{+ it ANAI $15 Lab#:______________________ _ § (circle tests) — Lab# (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2 Coliform P/A (oubhe supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) , , 3 Cobform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) • ; Ff 4. Fee?! Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) “ Microscopic | 6.5. Macroscopic " 6. Pesticides (507) ( Pesticides/PCB screen (508) - 6. PCB’s (Arochlors) (608/8080) . 7 Herbicides (SM-18/6640; 8151) / 22 . Lz.ARL 8.PCBasDec 9, Herbicides achl o robi p heny.(508A) (515) 10. Glycols in Water 8 Other Pesticides (SM-18/6630) .& . Other.

igerated?__ :___ yes_____ no (1) Pesticides (525) 11. Carbamate Pesticides (531) .,9. Petroleum Hydrocarbon Scan (310-13)

11. Acid Extractables (625/8270) - P Chionnated":_____ yes no 13. Diquat (549) 12. Glyphosate (547) 1 14. Chlorination Disinfection Byproducts (551) 12. Base Neutral Extractables (625/8270) 13. GC/MS Unknown Scan' 14. Purgeable Halocarbons (DEF) _ 2

Free Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16 Other Pesticides (SM-18/6630) 16 Pesticides (DEF) Total Chlorine Res: _ mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

INORGANIC ANALYSES REQUESTED - Lab# _ (circle tests = 22334 I CDN -Ce 1. Color Turbidity 20. Acidity 21. Alkalinity, as CaCOa (39. Aluminum 40 Antimony /59 Potassium 601 Selenium

4, pH_ 22. Bromide 41. Arsenic 61 . Silver ■I

15.. Corrosivity (temp._C) 24. Conductivity

25. Chl o ri Cyanide d e ----- 4 2 3. B ro mat e/C h l o ra t e 'C h l o r it e Barium :43 Beryllium 62‘ Sodium 63. Thallium 64 Vanadium ■ ■ 6. BOD (5 day) 7. Soluble BOD (5 day) 26.Fluonidemnn 44. Boron (49 Cadmium 65. Zinc CLP 217 ■ 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10. Dissolved Oxygen 27. Hardness, Total as CaCO 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N . 46. Calcium, as CaCO3 47 Calcium, Ca* 48 Chromium, Total 166.Metals/CN 67. Volatiles a 11. Total Organic Carbon 30. Nitrogen, Nitrite as N •t’r ( 'I, onatita : * •* s teni vol has, 12. Total Organic Halides 13. Solids, Percent (%) 32. 011 and Grease_ Copper e 31. Nitrogen, Total Kjeldahl as N (50, Cobalt t • Pesi/Pcls .--.i Dies ")soenratbies 4. Solids, Settleable. 33. Phenol . 52 Iron Lead 51 ITCLPM 71.TCLP-Metalsss a w 35. Phosphorus, Ortho as P 34. Phosphorus, Total as P 53 72.TCLP-Pesticides Total Dissolved 17. SolSoliidds.s, Total 18 Volatile 136. Sulfates d 56 Mercury -37.Suractants_ 54 Magnesium 55 Manganese 73.TCLP-Herbicides 174.TCLP-Volatiles._ 19. Other ■ 38.UV254rf0 Molybdenum isg Nickel s ,75.TCLP-BNA‘sg I I ■ tbseid Gss NYC-WTC_000026521