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Chain of custody form, Westchester County Labs, undated

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Westchester County Department of Labs and Research chain of custody form for environmental samples submitted by the City DEP.

NYC-WTC_000027042–000027044

Folder label: “23947

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18 JU ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 *57 (914)593-5575 _ NYS-ELAP No. 10108 gime/Date Set: _____ _________ C=0/S Form A-70 (rev. 1/96)

' Wamplu lypo (i in le one): G - 2573 , X/63,74 1 Potable 3. Non-Potable Treated Bomo s.PosssO 2. Non-Potable 4. Other _________ Chain of Custody? ’ ves' " no f f / , /) .{A r A Time/Date Collected:. Comments:___ Collected By: / • A/HAgency Code: _ .Source ID:. Type Descriptor.. Collected From: Bill to: Location's/Individual's Name..X Name/Company. Street______________________ Street________ City/St/Zip__________________ City/St/Zip_____ Identification of Source________ Phone#:,. Fax#:. Collection Point, AX CA, CH, BI? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:____________________ Lab _________________________ (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) © Volatile Halocarbons (524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. _ Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic (7) Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) B Other 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) AS Pesticides (525) 10. Glycols in Water Refrigerated? yes no T1. 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 Chionne 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)

8 _ _____ ______ pH. “ rm INORGANIC ANALYSES REQUESTED fLabl:______L (circle tests) 1. Color ’ t 20. Acidity < *Y —7— 39. Aluminum (Nota (s. p0ta8SiUmj 2. Turbidity 21 Alkalinity, as CaCOa 40. Antimony 60. Selenium « 3- pH 4. Conductivity 20 Bromide * 23 Bi jimate/Chlorate/Chlorite 41. Arsenic 61. Silver | .. 42. Barium 62. Sodium 5. Corrosivity (temp:______°C) °C) 24 Chloride 43. Beryllium 63. Thallium ‘ 6. BOD (5 day) 28.Gvanide 44. Boron 64. Vanadium Y 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 4814 Solids. Settleable 33. Phenol 52. Iron TCLP ( Solids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 1 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 5 NYC-WTC_000027043

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