Chain of custody form, Westchester County Labs, undated

NYC 9/11 Public Portal Document "tort

Ml ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Illestchester County (914) 593-5575 NYS-ELAP No. 10108 Time Date Set:_______________ — Form A-70 (rev. 1/96) SuppleType(circle one): 0030,327, 9455,0?05,029 1./Potable - 3. Non-Potable Treated Bottle *88/5, 878/.380 9,35457 8912,88/7 2. Non-Potable 4. Other _______________ _ Chain of Custody? yes .no Time/Date Collected: __ _________________ __ 1 Comments: Collected By: 6 ________________ Agency Code: .Source ID:_______ Type Descriptor.. PWS#:_________ Collected From: Bill to. Location’s/Individual’s Name. BroOklnt Name/Company Street_________ _ ____ . Street__________ City/St/Zip_______________ City/St/Zip______ Identification of Source_** Dep(A0* Phone#:._____ __ .Fax#:, i Collection Point, 29450 24352 | CA, CH, BI?. Check#:. . Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________ - Lab #: C" ' 2 Oy 2 (circle tests) La . “ (circle tests) 1. Heterotrophic Plate . 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 (606/8060) . $2 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) A 5. Microscopic 6 Pesticides (507) 6. PCB’s (Arochlors) (608/8080) * ( 7 Pesticides/PCB screen (508) 6. Macroscopic 7. Herbicides (SM-18/6640; 8151) * t s 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8,ther: 9. Herbicides (515) 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. Basel Neutral Extractables (625/8270) Chlorinated?: 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) Total Chlorine Res: .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

pH. INORGANIC ANALYSES REQUESTED - Lab#:. to .. '(circle tests) C. 1. Color 20. Acidity 39. Aluminum 59. Potassium ta) 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. 4. pH Conductivity 22. Bromide 23. Bromate/Chlorate/Chiorite 41. Arsenic 42. Barium 61. Silver 62. Sodium /lL4 5. Corrosivity (temp: .°C) 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs 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 Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14.Solids, Settleable 33. Phenol 52. Iron TCLP Uplids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_____________ 38. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000026870