Chain of custody form, WTC samples

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Document tracking environmental samples collected at the WTC site and transferred to a laboratory for analysis.

NYC-WTC_000027065–000027069

Folder label: “23993”

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NYC 9/11 Public Portal Document

111 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WLSTCHLSTER COUNTY L.ABGRATORIS AND RrSE ARCH 2 Dana Road, Valhalla, New York 10595 Ukis* lumary < »MV. 914)593-5575 6NS-ELAP No. 10108 Ame/Date Set: • Form A-70 (rev. 1/96)—

raseH956d4,F740,1‘61W3 Dor] tple Type (circle one): 1/Potable. 3. Non-Potable Treated Bottle #‘s:H par* (2' 62 C & /*1- 2. Non-Potable 4. Other______________ Chain of Custody?.... ... _yes_____ no * 4 *-t " —bk Time/Date Collected:_ L TO Comments:_____ _ _ _____ /

Collected By:_L_ ___ _ ____ Agency Code:_.... PWS #: Source ID: Type Descriptor:

Collected From: a Bill to: IA Location’s/ndividual’s Name_ 1. Name,'Company____ Street ____ ___ _t.. K =_DL E Street______ City/StZip_ 10/4 _MM_0 City/SiZip. f Identification of Source_. Phonet_ _ - Fax#: Collection Point I CA. CH, Bl? Check#; Amounts

■ BACTERIOLOGICAL analyses”" ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:. .____ _______________ ___ (circle tests) Lab#GRheddi (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 22 Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) (3 J Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw. stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Feal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. . PCB’s (Arochlors) (608/8080) ] 6. Macroscopic (72) Pesticides/PCB screen (508) 7: Herbicides (SM-18/6640; 8151) Z.ARI 8. PCB as Decachlorobiphenyl (508A) 8 Other Pesticides (SM-18/6630) @he__ ___ __ 9. Herbicides (515) 1 -9. Petroleum Hydrocarbon Scan (310-13)

Refrigerated?.... ..... yes______ no (10) Pesticides (525) 11. Carbamate Pesticides (531) 99=d 10. Glycols in Water 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated'’: . ........ yes______ no 13. Diquat 549) 14. Chlorination Disinfection Byproducts (551) - 13. GC/MS Unknown Scan 14. Purgeabie Halocarbons (DEF) Free Chione Res: _mg/L .15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16 Pesticides (DEF) "Total Chlorine Res: _Tg/L 17 Petroleum/Hydrocarbon Scan (2110-13) 17. PCB’s (Arochlors) (DEF)

LpH__ "44 )0* -a' i . ANA! ‘ >H" (*et n : . • (circle tests) 1. Colorp 2 Turbidity 3_H 4. Conductivity A 26. Acidity 21; Alkalinity, as CaCOa 22. Bromide 2177 23. Bromate/Chlorate/Chlorite 39 Aluminum (40.Antimony 41. Arsenic 42, Barium w e 59. Potassium 60. Selenium 61. Silver 62. Sodium 5 Corrosivity (temp: _ _°C) 24, Chloride (43.-Beryllium (63. Thallium (64. Vanadium 6. BOD (5 day) 25. Cyanide 44. Boron 7 Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 26. Fluoride v 27. Hardness, Total as CaCO3 45. Cadmium 46. Calcium, as CaCOa 65. Zinc ICLP_ __________

9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium. Ca" 66. Metals/CN 10. Dissolved Oxygen 11.1 otal Organic Carbon 29. Nitrogen, Nitrate as N 30. Nitrogen, Nitrite as N 48. Chromium, Total 49. Chromium, Hexavalent 67. Volatiles i bi fomi volatilen (50. Cobalt 2,9= 12. Total Organic Halides 13. Solids, Percent (%) 32. 011 and Grease 52.tron-1 33.Phenol 31. Nitrogen, Total Kjeldahl as N 51. Copper - e 1 ■- sti PPOs A) i > : F ! talyos TCLP 14Solds. Settieable thy ■' • 34. Phosphorus, Total as P 53.Lead. 71. TCLP-Metals 1o. Solids, Total fyoet 36. Sulfates _ .54.55. Manganes Magnesium e 35. Phosphorus, Ortho as P e 72.TCLP-Pesticides 73:TCLP-Herbicides 118. Solids. Total Volatile adna 37 Surfactants n 56. Mercury te .17. Solids, Total Dissolved

(9 Other SA- 38.U/V254ns (57/Molybdenum t 74. TCLP-Volatiles . -75.TCLP-BNA‘ss - ■ 58. Nickel' ■

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