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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 * Westchester WWiv.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH Bott ‘ , 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 1/96)

Sample Type (circle one): 0084,0519,0391 ,3009,4624 1. Potable 3. Non Potable Treated Bottle #s:2409, 240,3 764, 3933 8966 2. Non Potable 4. Other ._________ Chain of Custody? yes no Time/Date Collected: 200/ ■ A Comments: Collected By: s " i / dp 11 Agency Code: _ Source ID: Type Descriptor: Collected From: - , Bill to: Location's/ndividual's Name. OQvtew) Nose+VOl Name/Company _ Street_____________ __________ ;____________________ Street________ Clty/St/Zip________ _ ________ ____________________ _ City/St/ZIp Identification of Source __ ______ __ Phone#: Fax#: Collection Point 4 .. t CA,CH, Bl? Check#: Amounts. 4 BACTERIO‘LOGCALANALYSIS, • — q. , ORGANIC POTABLE ANALYSIS e ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:__ _ ' Lab#:__________ (circle tests) ; " (circle tests) T 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) 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 (ad samples) 5. Microextractables (504) 1 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) , 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic * 7.Pesticides/PCB screen (508) 7. Methoprene (618) ZPI 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) other___ 9. Herbicides (515) 9. Pesticides (SM18/6630) ; Refrigerated? _ yes • no 10. Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13): 11. 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:. _mg/L 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. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF)* 18. Other_______________________ 18. Other:_____________ __________

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity 20. Acidity 21. Alkalinity, as CaCO3 230 -J7Aluminum 40. Antimony 59. Potassium 60. Selenium t- 1227 . ■

3. pH 22. Bromide 41. Arsenic 61. Silver 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 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs 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 8. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 36. Sulfates 55 Manganese 72.TCLP-Pesticides 17. Solids, Total Dissolved 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 38. UV254 57 Molyodenum 74. TCLP-Volatiles 19. Other________________ 75.TCLP-BNAs 58. Nickel T A. . 4 — NYC-WTC_000026699

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