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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_000026837–000026841

Folder label: “23797”

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NYC 9/11 Public Portal Document

| ENVIRONMENTAL SERVICES SAMPLE SURMSSON FORM 1 J HI ilet :pty **t WESTCHCSTEH COUNTY LAEORATGHLS ANT HSLARCli 2 Dana Road, Valhalla, New York 10595 (914)593-5575 -NYS-ELAP No. 10108 Li(g*

: on i A-fi (rev. trea J atr ’ Mample Type (circle one): C67 AUX $5/00 c • A/dory .1. Potable' . No ; ‘oto -3 "feoller ? Botte/d: /. - /? P 00/ g 75 PAs s__ I 2. Non-Potable 4. Other___ Chain of Custody?_____ yes_____ no Time/Date Collected: ■ 002*4***

Collected By• ___ Agency Code.__ PWS #:_______ Source ID:..... Type Descriptor:.... Bill to: Location’s/Individual’s Name... ............. ....... A.L _ ___ Name/Company _ Street AKTAAAPe Street.____ ____ City/StZip______ L. 2___ *2 ...... - _ City/StZip_______ Identification of Source___ ___ ____..... .. .. ........ .. . MPhonel. Fax #: Collection Point . F CA. CH. BP Check# e Amounts

A/ O::!'! * tdAl ANAI.VSI S OHL4N/G t/RHs J AMar . • ANI NONPO/AN /(Ni3 ANALYSES Lab#:. _______ ___ _____ _______ circle tests) LabWm -(circle lests)—eeeAmum 1, Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 3/ Volatile Aromatics (524) 2 Coliform P/A (public supplies) 3 Acrolein & Acrylonitrile (624) 3. Cofiform MPN (priv well, raw, stp) 4. Total Tnhalomethane Potential (510) 4 Phthalates (606/8060)

-6>75 Herbicides (SM-18/6640; 8151) | 4. Fecal Coirform (all samples) 5. Microextractables (504) Organochionne Pesticides (608/8080) j 5. Microscopic 6. Pesticides (507) - ! PCB’s (Arochlors) (608/8080) | 6 Macroscopic 73 Pesticides/PCB screen (508)

7API . other 8. PCB as Decachlorobiphenyl (508A) : 9. Herbicides (515) 18 .9 Other Pesticides (SM-18/6630) Petroleum Hydrocarbon Scan (310-13) 1 ONPesticides (525) 10. Glycols in Water Refrigerated?__ _ .yes........... no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chionnated?: .yes____no 13, Diquat (549) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chonne Res mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticraes (DEF) Tota Chonne Res: . mg/L 17. Petroleum/Hlydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

su > - . AR, : h s hi out mn 2747 I(circle tests) 1, Color--- 20. Acidity 39. Aluminum 59. Potassium 2. Tubidity 21. Alkalinity, as CaCO3 :40. Antimony (60. Selenium 3H 22. Bromide ■ ,41 Arsenic.'. ! 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite | 42.' Barium".: i 62. Sodium 5 Corrosivity (temp:.... ....... °C) 24. Chloride 143: Beryllium | 63. Thallium 6. BOD (5 day) 25. Cyanide n-e 44. Boron 164/ Vanadium 55. Zinc___ 7. Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 26. Fluoride 27. Hardness, Total as CaCOa 28. Nitrogen, Ammonia as N 45, Cadmium 46. Calcium, as CaCOa 147 Calcium, Ca+2 cLPms 66. Metals/CN 10. Dissolved Oxygen 11. Total Organic Carbon 29. Nitrogen, Nitrate as N 30. Nitrogen, Nitrite as N 48) Chromium, Total 49. Chromium, Hexavalent 67. Volatiles ( 6. Semi V' tk? 12. Total Organic Halides 13. Solids, Percent (%) 33 Phenol 31. Nitrogen, Total Kjeldahl as N

----- /52ton 32. Oil and Grease (51 Copper 550. Cobalt 69. Pesticides/PCB’s -'it. Nsk ! jotss r lee ■ TCLP 34. Phosphorus. Total as P " I 53 Lead r 4. Solids, Settleable n. 11 MMelli 16. Solids, Total 36. Sulfates soeenid ■ 54. Magnesium 15. Solids, Suspended 35. Phosphorus, Ortho as P /. 1 Cl i’ Poat dfo: 17 Solids, Total Dissolved 55; Manganese R IG!I etbiider 37. Surfactants—ea 56, Mercury /4. U.l PVs 19. Other-5AT dsmme 38.1IV254 57. Molybdenum 18. Solids. Total Volatile / (01/ 1158 Nickel ende NYC-WTC_000026839

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NYC-WTC_000026839Source: NYC Law Department, mirrored locally

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