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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_000026753–000026756

Folder label: “23697

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NYC 9/11 Public Portal Document

ATs ill ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH

IUestchester County 2 Dana Road, Valhalla, New York 10595 TTEE(914)593-5575OT hr NYS-ELAP No. 10108 be/Date Set: Form A-70 (rev. 1/96) mple Type (circle one): 67 S /2 1. Potable 3. Non-Potable Treated ) r . " • / , Bottle #‘s: _ 1* ■■ 99 /$ 2. Non-Potable 4. Other Chain of Custody7 . ..... ....yes... no C P 23 7 - 44 1 ( S ‘ 4/ 4 J Time/Date Collected://. . J.---- Comments: Collected ByL Agency Code PWS #... .. Souman ID:• Type Descriptor: Collected From: . Bill to: Location’s/Individual's Name --- ‘ Name/Company Street I £____ /. 14 y_ 5 Street_________ J / / (.1 1 7 .g III City/StZip City/StZip. mu in Identification of Source_____ S.. a... . Phone#: . I CA. CH. BP Fax # Collection Point . _ -_______ ____ _ ...... Check#:.......... .Amounts....

BACTERIOLOGICAL ANALYSES' ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab# Lab #:___ _ ___ _ ______ ______ .... (circle tests) T HeYSrotronhic /date 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count themodlazysis & all others) ( 2.7 Volatile Halocarbons (524) 2. Coliform P/A (public supplies) ( 3) Volatile Aromatics (524) i 3. Coliform MPN (priv well, raw, stp) "4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4 Fee al Coliform (all samples) 5. Microextractables (504) _5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) ' 6.. PCB’s (Arochlors) (608/8080) 6. Macroscopic 7. Pesticides/PCB screen (508) 7 ’ Herbicides (SM-18/6640; 8151) API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)

Or--. -... -.. - Retngerated? ...... ...yes__ ___ no 9. Herbicides (515) C 10? Pesticides (525) 11. Carbamate Pesticides (531) 9. Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chignnated?: yes .. .no 1 3. 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) i 16. Other Pesticides (SM-1 8/6630) 16. Pesticides (DEF) i Tola Chlorine Res: ..._mg/L 17. Petroleum/Hlydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF) i

pH.... —B—' -87.-.- INORGANIC ANALYSES REQUESTED - Lab#:... _.. _ r. -. L. .. .. (circle tests) i. 20. Acidity- /39. Aluminum 59. Potassium Tubidity 21. Alkalinity, as CaCOa j 40. Antimony / 60. Selenium ■ ■| pHMaeem 22. Bromide ■ 41.; Arsenic ( 61. Silver i 62. Sodium U 4. Conductivity 23. Bromate/Chlorate/Chlorite . 42. Barium 5. Corrosiv ity (temp:...... _.. °C) 24. Chloride | 43. Beryllium I 63. Thallium ROD (5 day) 25. Cyanide 1-44. Boron < 64 Vanadium 71 Soluble BOD (5 day) 26. Fluoride i 45. Cadmium -65. Zinc 6 Carbonaceous BOD (5 day) 27. Hardness. Total as CaCO 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 Haldes 31. Nitrogen, Total Kjeldahl as N .<"'50,. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease j 51 Copper 70. Disk Deliverables L Solids, Settleable 33. Phenol 52. Iron TCLP 5. Solds, Suspended 34. Phosphorus, Total as P 58. Lead 71. TCLP-Metals 16 Solids, Total 35. Phosphorus. Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 1 55. Manganese 73' TCLP-Herbicides 18 Solids. Total Volatile 37 Surfactants { 56. Mercury 74. TCLP-Volatiles 19 Other *_ ' : 38.UV254 | 57. Molybdenum i 58. Nickel 75. TCLP-BNA's

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NYC-WTC_000026695 · Box DEP Box 19

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

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