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Chain of custody record, Westchester County Labs, undated

Machine-extracted title · confidence 85%

Westchester County Department of Labs and Research chain of custody form for environmental samples submitted by the City DEP.

NYC-WTC_000026695–000026702

Folder label: “23650

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NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH iv.com 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 A NYS-ELAP No. 10108 yOateSet: CC Sd Axl. 4.72 wla LC Form A-70 (rev.1/96)

Sample Type (circle one): 6962, 8753,89/3*37,6608,620 (1.Potable 3. Non Potable Treated Bottle #s: 00138975,8003 6699 %70/,87u/ 2. Non Potable 4. Other ____________________ Chain of Custody? yes no Time/Date Collected: zad / - (825 Comments: Collected By: J Pol tA Agency Code: _ Source ID: .Type Descriptor Collected From: Bill to: Location’s/ndividual’s Name plolatak Name/Company Street Street________ City/St/Zip *4 City/St/Zip_____ Identification of Source - * - 3 : •. __ D&PLADA ,; Phone#: Faxi: ' 290 7 2, Collection Point ...4 aBu Q $D Fese BACTERIOLOGICAL ANALYSIS ‘ i CA,CH, BI? Check#: Amounts.

ORGANIC POTABLE ANALYSIS f ORGANIC NONPOTABLE/SOLID ANALYSIS l ah#- ~ ’ ***** Lab#:____________________ (circle tests) r (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) .olatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Conform (an samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) , 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) ft 6. Macroscopic “7.Pesticides/PCB screen (508) 7. Methoprene (616) ’n

Gr— -8. PCB as Decachlorobiphenyl (508A) i. Herbicides (515) 1 Pesticides (525) 8. Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630) 1D Petroleum Hydrocarbon Scan (310-13) i Refrigerated? yes no -1. 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) - Free Chlorine Res:. _____ _ 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan , Total Chlorine Res: _______ mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroteum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other._______________________ 18. Other_____________________ __

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity )255) 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver j . .2 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 I

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-violatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables 14, Solids, Settleable 33. Phenol 52. Iron TCLP (Solids, Suspended 34. Phosphorus Total as P 53 .Lead 71 .TCLP-Metals TO. 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 57 Molybdenum 74. TCLP-Volatiles 19. Other________________ 38. UV254 75.TCLP-BNAs 58. Nickel ■ ... .... kkkdz NYC-WTC_000026698

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NYC-WTC_000026698Source: NYC Law Department, mirrored locally

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