Chain of custody record, Westchester County Labs, undated

NYC 9/11 Public Portal Document ... * .. 1

XXI,“rase i ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM OV WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 : (914)593-5575 . NYS-ELAPNo. 10108 late Set: Form A-70 (rev. 1/96)

Ie Type (circle one): 046 2,4 ■ 1) Potable *" 3. Non Potable Treated Bottle #‘s: ' 4. _ _ 2. Non Potable 4. Other ........................ Chain of Custody?. ves —: no Time/Date Collected: _/G/2 Comments: Collected By: A Ges +&i k Agency Code: _____ PWS # _ Source ID: Type Descriptor: Collected From: ; Bill to: . Location’s/ndividual’s Name /A/A ‘A 7 IAp Name/Company Street — Street _ n ---=-====554-------------------------------------------

City/StZip City/St/Zip _ Identification of Source _ D&/LA0# Phonet Fax#:__________________ Collection Point, .. 32350 24200 CA,CH, Bl? Check#: ------- -- --------------------- ----- ----------- Amounts-------------- _________ — BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE 07 07 'SIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#: Lab#: ) / (circle tests) (circle tests) C— - —l 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 (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic 0 6. Pesticides (507) 6. PCB's (Arochlors) (608/8081) > 6. Macroscopic _ 0 (77 Pesticides/PCB screen (508) 7. Methoprene (616) —

3 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 10.) Pesticides (525) 8. Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630) 10. Petroleum Hydrocarbon Scan (310-13) —wm

Refrigerated? yes no 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: 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) mg/L 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other _ 18. Other 0 — INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity . Y 39. Aluminum ho ' - 59. Potassium : 2. Turbidity 21. Alkalinity, as CaCO3 ■ 40. Antimony 60. Selenium 1 3. pH 22. Bromide - 41. Arsenic 61. Silver 4. Conductivity ■ 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp:. °C) 24. Chloride 25. Cyanide 43. Beryllium 44. Boron : : 63. Thallium 6. BOD (5 day) 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 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*a _ 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 33. Phenol 52. Iran 14, Solids, Settleable / TCLP MMolids, Suspended 34. Phosphorus Total as P 53.Lead ’ 71 .TCLP-Metals T.Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73. TCLP-Herbicides 37. Surfactants 56. Mercury 18. Solids, Total Volatile 38. UV254 57 Molybdenum 74. TCLP-Volatiles 19. Other:__________________ 75. TCLP-BNAs 58. Nickel

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