Chain of custody record, Westchester County Labs, undated

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

88 Iiestchester County WEST CHESTER COUNT Y I ABORATORI S AND BE MARCH

(914 593-5575 2 Dana Road, Valhalla, New York 10595 da A , N YS- ELAP No. 1C i 08' Form A-70 (rev. 1/96) ame/Date Set: " -Sample Type (circle one): —C02,L61/7(70, *(? 46/7, TopBinMKC* 1. Potabie.) 3. Non-Potable Treated *hFN20,2*77121 **82 " , BHt , / E7i

2. Non-Potable 4. Other______ _ __________ ____ Chain of Custody?......... ..yes_____ no Time/Date Collected: 9 3 o 44444_ Comments:______ )4 Collected _ Agency Code:_ PWS #: Source ID:_______ Type Descriptor:___ Collected From: , , -* 26. Location’s/Individual’s Name___ z ____ De............. ....... . Name/Company,

Street 1 ? 4 ‘ * /—2 _. Street City/SVZip_t kS. City/St/Zip identification of Source __ ____ _ ___ ____ _ ___ Phone#.__ . Fax#:... Collection Point _____ __ ____ [ CA, CH, BP Check#:___ Amounts

BACTERIOLOGICAL ANALYSES "’organic POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________ _________ Lab #:____________ ___ (crcie tests) (circle tests) 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. Col'form MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (010) 4. Phthalates (606/8060) 4. Feral Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 7 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic 7 Pesticides/PCB screen (508) .7. Herbicides (SM-1 8/6640; 8151) 8." PCB as Decachlorobiphenyl (508A).' 18 Other Pesticides (SM-18/6630) 3. Otrer ___ __ ________ _ 9 Herbicides (515) 2 " 9. Petroleum Hydrocarbon Scan (310-13) 10, Pesticides (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) Chton nated: yes___ . no 13. 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) 16. Other Pesticides (SM-18/6630) 16 Pesticides (DEF) 7 ota Chlorine Res: mg/l. 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

PH__ 012 . N* ANAI := HT GUI Slid) : abe (circle tests) e 1. Color 20. Acidity . 39, Aluminum ■ ■■ * Pmashan / 60. Selenium 2. T urbidity 21. Alkalinity, as CaCOa 40. Antimony ‘ 3.4, PH_ Conductivity 22. Bromide 23. Bromate/Chlorate/Chlorite i 41. Arsenic) : 42 Barium 1 I 1 61/Silver 62. Sodium 5. Corrosivity (temp: _.. °C) 24. Chloride Y 43: Beryllium ’ : 63. Thallium 6. BCD (5 day) 25. Cyanide 44. Boron 64 Vanadium 7. Carbonaceous ■ Soluble BOD (5 day) BOD (5 day) —26. Fluoride etr 27. Hardness, Total as CaCOa <45) Cadmium 46. Calcium, as CaCOj 65. Zinc CLP_ 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47) Calcium, Ca" 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 148/ Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium. Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N /50 Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. 011 and Grease 51 Copper . 70. Disk DeliverabIes , 14. Sohds, Settleable 33. Phenol o 52 iron TCLP_ 71.TCLP-Metals 16. Solids, Total --- 134. 15. Solids, Suspended ■ . •35. Total asasR Phosphorus. Ortho Phosphorus. R. Lead 53 54) Magnesium 72. TCLP-Pesticides

18. Sol id s. Total Vol a ti l e in —36. Sulfates ----- ’73. TCLP-Herbicides

■ 17. Sohds, Total Dissolved 551Manganese

19 Other G ( 138/UV254_ 37. Surfactants — « 56 Mercury s 74. TCLP-Volatiles PgN/E Molybdenum i Nickel

NYC-WTC_000026841