Chain of custody record, Westchester County Labs, undated

NYC 9/11 Public Portal Document i

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 8‘e I WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 : ' ■ • NYS-ELAP No. 10108 Time/Date Set: C_________ __ __ ------------ —2a=/2823,k— Form A-70 (rev. 1/96)

Sample Type (circle one): 1. Potable 3. Non Potable Treated Bottle #‘s: _ 2'. Non Potable 4. Other Chain of Custody? - yes < no Time/Date Collected: 9) / 20 / / / CO Comments: _ Collected By: H, PATL Agency Code: PWS #_________ Source ID: Type Descriptor: Collected From: Bill to: 7 Location’s/Individual’s Name Name/Company 4 ■

Street _ __ ggut"ss___ Street _ City/St/Zip ............................. City/St/Zip _ —1 Identification of Source _ b<2.646# Phone#:' Fax#: — n —. Collection Point _SSO 7 4230 CA.CH, Bl? ~ Check# - Amounts —— ----------------------------------------------------------------- BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID AN Lab#: Lab#: (circle tests) • " ' ) 7 - 77 • // _ __ . • e (circle tests) 7 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ( Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) . . 2. Coliform P/A (public supplies) 3. Coliform MPN (privwell, raw,stp) (3)4. Total Trihalomethane Potential (510) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (625/8270) S3

4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. PCB's (Arochlors) (608/8081)' 6. Macroscopic (2 Pesticides/PCB screen (508) 7. Methoprene(616) Uer 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) n a 0n —_ 9. Herbicides (515) 9. Pesticides (SM18/6630) 2 Refrigerated? yes no 10) Pesticides (525) ' 10. Petroleum Hydrocarbon Scan (310 13) *11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) - -J 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 (SM 18/6630) 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 20. Acidity 39. Aluminum ' 2 59. Potassium c iJ 21. Alkalinity, as CaCOa 40. Antimony . 60. Selenium , (5 2. Turbidity 3. pH 22. Bromide 41.Arsenic • 61. Silver //U 4. Conductivity 23. Bromate/Chlorate/Chlorite 42.Barium i — 62. Sodium V 5. Corrosivity (temp:. 24. Chloride 25. Cyanide °C) 43. Beryllium 44. Boron 63. Thallium ) 64. Vanadium 6. BOD (5 day) 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+® ' 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 (olids. Suspended 34. Phosphorus Total as P 53.Lead . ' 71 TCLP-Metals TOSolids, Total 35. Phosphorus, Ortho as P 54 Magnesium . e 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 1 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:............... 38.UV254 ■ r 57 Molybdenum 75. TCLP-BNAS 58. Nickel : :

NYC-WTC_000026781