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Chain of custody record, Westchester County Labs, undated

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Westchester County Department of Labs and Research chain of custody form documenting the transfer of environmental samples.

NYC-WTC_000026585–000026588

Folder label: “23471

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NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Westchester dinngovcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 e NYS-ELAP No. 11s ime/Date Set: Form A-70 (rev. 1/96)

Sample Type (circle one): Bottle #s? « "" 88875. 1. Potable % 3. Non Potable Treated -- ----- — v ______ J 2.Non Potable 4. Other Chain of Custody? yes no } ■

Time/Date Collected: 202 1/54//.. — Comments: Collected By. ==s. Agency Code:..... PWS ______ __ _ _ Source ID Type Descriptor:.. Collected From: Bill to: Location’s/Individual ,41 ’s Name A J 1. A_ PPP 5 , Name/Company Street .. L/......../) 4 I Alle _ LAo__ ,..... ... Street---------- — City/StZip Ua /he Ha , - 1 0 595 City/St/Zip _ Identification of Source _.... _.... _%_____ ■ Phone#:. Fax#: Collection Point _ _____ CA,CH, Bl? _.. Check#: Amounts.... 9999 BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS i Lab# ====== Lab#: -..... —Cn2 (circle tests) (circle tests) 1. Heterotrophic Plate 1 Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2] Voiatile 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) .APIMacroscopic

8. Other:_______ _ ___________ (7, Pesticides/PCB screen (508) Us PCB as Decachlorobiphenyl (508A) 7. Methoprene (616) 8. Herbicides (EPA1978/8151) 9. Herbicides (515) 9. Pesticides (SM18/6630) fo Pei ! ( . 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated?yes___ no <1t 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) ree Chlorine Res: mg/L 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res:... . mg/L 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) PH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other: 18. Other:■ 1... INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity /39. Aluminum ybve, 1 7 / 59> Potassium ; /l / 2. Turbidity 21. Alkalinity, as CaCO3 / 40. Antimony 60. Selenium ! 3, pH 22. Bromide 23. Bromate/Chlorate/Chlorite | 41 Arsenic ( 42 Barium 61. Silver 4. Conductivity 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 Ign 45,Cadmium 46. Calcium, as CaCOa . 65/Zinc— s d i 1 * i "-.'.-: ! 1 (5 dm 1 27. Hardness. Total as CaCO3 MP ? GmnOma Demand 28 Nitrogen, Airronia as H 47:Calcium, Ca "2 no MIAtPN 48.Chromium, Total 10. Dissolved Oxygen 1 Ialompasent ) :9 Niticon tor . - N 0 Nittogi it. r tit ; N 1 Narogen ■-• di: . i; 49. Chromium, Hexavalent ,50.Cobalt t/. V allies 66 Smm* -vd.-Jjl.- 12. Total Organic Halides 69 Fectichet’Ci 13. Solids, Percent (%) 32 Oil an Grease 51 .-Copper . DS tolivanzidne 1. Solids, Settleable -33, Phenol 52 1ron 20217140777 ITCLP .5, Solids, Suspended 34. Phosphorus Total as P l 53.Lead /10 P Me Li!. 35. Phosphorus, Ortho as P 54 Magnesium 0 17, Solids. Total Dis olved I 16. Solids, Total

18. Solids. Total Volatile r 36. Sulfates 37. Surfactants | 55; Manganese ( 56 Mercury l ■: * i -Purda ploe A G Pu kbicios A IC ! -Veatilcr 19. Other G2.//s 777 38.UV254 * 57 Molybdenum s 58. Nickel 75. TCLP MNR

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