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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 ester ovcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96) Ghpietype (circle one): 2933,8701 . cozo 4*15,1909,0022/1* otable 3. Non Potable Treated Bottle #s: 3703,869 .294 8759, 8127 *sty 2. Non Potable 4. Other_____________________ Chain of Custody? yes no Time/Date Collected: _ _________________ _ Comments: Collected By:. tS4___ __ Agency Code: _ Source ID: Type Descriptor: Collected From: Bill to: Location’s/Individual’s Name Ousos Name/Company Street________________ Street________ City/St/Zip_____________ City/St/Zip Identification of Source' * ______ DeP L6# Phone#:______ Fax#: Collection Point_ _ _____ *- ia; -■ *41^ .29 8/ CA.CH, Bl? Checkif: Amounts. . 1- ................................. BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_____________ Lab#:______________________ (circletests) ar 4 (circle tests) 1. Heterotrophic Plate.' 1Trihalomethanes (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. Coliform MPN (priv well, raw, stp) (3. Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (625/8270) e n ri' 4. Fecal Coliform (aS samples) 5. Microextractables (504) 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 (616) 7API 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) _______________________ 9. Herbicides (515) 9. Pesticides (SM18/6630) Refrigerated?— yes no 10.Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13): Hr 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 Samivolatile 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___________________ _

T INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity 20. Acidity 21. Alkalinity, as CaCO3 50 G 39. Aluminum 40. Antimony ) y. 59. Potassium 60. Selenium: t2 co 6 - < ■

3. pH 22. Bromide 41. Arsenic 61. Silver j 4. Conductivity 23. Bromate/Chlorate/Chiorite 42. Barium 62. Sodium ? . 5. Corrosivity (temp:__ °C) 24. Chloride 43. Beryllium 63. Thallium / 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium I A 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc } V 1 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 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 JSollids. Suspended 34. Phosphorus Total as P 53.Lead 71 .TCLP-Metals “Solids. Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 37. Surfactants 56. Mercury 73. TCLP-Herbicides 18. Solids, Total Volatile 74. TCLP-Volatiles 19. Other___________ 38. UV254 57 Molybdenum 58. Nickel 75.TCLP-BNAs

NYC-WTC_000026702

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