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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 for environmental samples submitted by the City DEP.

NYC-WTC_000026611–000026618

Folder label: “23497

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NYC 9/11 Public Portal Document WMWHP mairos C) WPAUJWLLTTU"ASAI "I

J ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Ml sDatosoe___ X ( WESTCHESTER COUNTY LABORATORIES AND RESEARCH

W) - 2 Dana Road, Valhalla, New York 10595 (9141,5935575 WHW, J t / 1 00_________ 15 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) imple Type (circle one): 6013,80901005/,8o",3050,30S1,0271 1) Potable 3. Non-Potable Treated Bottle ws&lol(,83893080,80986011QFP ■ ’ » J 2. Non-Potable 4. Other____________________ Chain of Custody? yes no Time/Date Collected:2/2M/200/—929 Comments: Collected ByC - 1 su l_________ Agency Code: PWS #: .Source ID:. .Type Descriptor. Collected From: Bill to: Location’s/individual’s Name. __ _______________ Name/Company Street______ _ ________________ _ ____________ .. Street _______________ :___________ _______________ Citv/SUZi Identification of Source-. DeDLAO* Phone#: Fax#: Collection Point . 4/2150 2894 2— _ | CA, CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES : ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: . (circle tests) Lab *_U44: (circletests) . . 2. / •/ ‘ : .-■ 1. Heterotrophic Plate 1. Trihalomethanes (524) 7 e 1. Purgeable Halocarbons (624/8260) Count (homodialysis & all others) 2 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 (606/8060) 63 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 2 ? 5. Microscopic 6. Pesticides (507) . 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic - 7. Pesticides/PCB screen (508) . 7. Herbicides (SM-18/6640; 8151) 17 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) BeOther: ________ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) ' i 10. Pesticides (525) . 10. Glycols in Water Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) " 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) 7 Chlorinated?:____ ves no 13. Diquat (549) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) 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)

pH A INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) C. -• 1. Color 20. Acidity 39. Aluminum 59. Potassium •s " 2. T urbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium l 2 3. PH 22. Bromide 41. Arsenic 61. Silver : ((/ 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium f 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 CaCO3 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 14. Solids, Settleable 33. Phenol 52. Iron TCLP Golids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals T9.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 qA * 74. TCLP-Volatiles 19. Other:____________ 38. UV254 57. Molybdenum 75. TCLP-BNA’s mosoncenen 58. Nickel _____ ----------- St ... skta NYC-WTC_000026614

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