Chain of custody form, WTC samples

NYC 9/11 Public Portal Document

LmAIS III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LAPORATORIFS AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Ulestchester(ounty _2(914)593-5575 d s NYS-ELAP No. 10108 3 Form A 70 (rev. 1/96) - “me/Date Set:________ ________ tmpleType (circle one): ’ 1. Potabie D 3. Non-Potable Treated 1 C r 1207 HlmolKsbzln 2AE/MArcs Bottle #‘s:__0_ 2. Non-Potable Time/Date Collected: 1(30 4. Other 10=)*c ( Chain of Custody?___ Lyes___ Cemaptaipgys ino"URWK(129ne amkRBB.ANE Collected BycoIT__ Agency Code: PWS #:_________ ___ Source ID’_____ Type Descriptor: Collected From: Bill to: Location's/ndividual's Name... DY L Name/Company _ Street... ..... [ t* t 2 36 Street___________ Citv/SVZi VALHALLA.... PY (6046 Cny/St/Zip_______ Identification of Source__ _______ _ ______ ____ _....... Phone#: ..... ......... Fax #: Collection Point DEt9 CA, CH. Bi? Checks: Amounts

Ael8 etooA: /NAi YSi 6 ORGANIC POTABLE ANALYSES (rid NC NONPOIARL i AYH.IB ANAI ri $ Labi (circle tests) Lab __ ___ _ __________ fcircle tests) — 1. Heterotrophic Plate 1, T rihalomethanes (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) 4. Fecal Coliform (all samples) 5. Microextractables (504) . >. - -nn Ho me* l ’>• .fr : (GQM/SO/0) 5. Microscopic 6. Pesticides (507) -6, PCB's (Arochlors) (608/8080) 6. Macroscopic 7.) Pesticides/PCB screen (508) 7-. Herbicides (SM 18/6640; 8151) 7API 8. PCB as Decachlorobiphenyl (508A) 8 Other Pesticides (SM-18/6630) Other: 9. Herbicides (515) 9.7 Petroleum Hydrocarbon Scan (310-13) 10./Pesticides (525) 10. Glycols in Water Remngerated?__ yes___ no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated7. yes_____ no 13. Diquat (549) . 14. Chlorination Disinfection Byproducts (551) 13. GC/MS Unknown Scan 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__ /_ :3 A* . ANAI * !- HE ‘21 STED .* (circle testsee 1.Colomep ! 2. Tutbiditv 20. Acidity 21. Alkalinity, as CaCOa 39. Aluminum (40. Antimony 1005 A Vf 59. Potassium 60. Selenium 3JH j 4. Conductivity 22. Bromide 23. Bromate/Chlorate/Chlorite 41, Arsenic 42. Barium It” 61. Silver 62. Sodium j 5 Corrosivity (temp: _°C) 24. Chloride (43. Beryllium (3. 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) 9. Chemical Oxygen Demand 27. Hardness, Total as CaCOa 28. Nitrogen, Ammonia asN 46. Calcium, as CaCOa 47. Calcium, Ca*? . CLPUT 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total , ; 67. Volatiles - 11. Total Organic Carbon 12. Total Organic Halides 13. Solids, Percent (%) (50.Cobalt) 30. Nitrogen, Nitrite as N 31. Nitrogen, Total Kjeldahl as N 51. Copper 1 49. Chromium, Hexavalent Gs Semd voloter 69 jh- " / ‘ !: :

‘4.Solds, Settleable - ( 33 Pheno "" 53.Leadeanee 52.ton2nn 32. Oil and Grease /0. I) 1 )liveral or TCLP_ME 71.TCLP-Metals — 36. Sul f ate s 34. Phosphorus. Total as P 54. Magnesium e-< 35. Phosphorus, Ortho as P 55. Manganese 72.TCLP-Pesticides 73-TCLP-Herbicides 18, Total Volatile_ 37Surfactants Solids.SAT 17. Solids, Total Dissolved

(other _56Mercury Ma(57, Molybdenum 38. 1/V254 74.TCLP-Volatilesa 75.TCLP-BNA‘s 2$1058.Nickel"U NYC-WTC_000027067