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Chain of custody form, WTC samples

Machine-extracted title · confidence 90%

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

eyeweeaee P115 s III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY I ABORATORIS AND REST ARCH orPae 2 Dana Road, Valhalla, New York 10595 Uestchester County 14593-5575 ,NYS-ELAP No. 10108

me/DateSet:_____________ :___ Form A-70 (rev. 1/96) Cemple Type (circle one): orBAEo0C920 ZpreM=96Lko Bottle #‘s:_ __2ifc P. .1 5027 . ( Potable 3. Non-Potable Treated 2. Non-Potable 4. Other_ Chain of Custody? yes no L ) ( , LEEIl"ULD Time/Date Collected: K1t_ jo-c1-0k. Comments: - - ---------------------------------------- Collected BytCT _Agency Code:___ PWS #:............. . Source ID: Type Descriptor: Collected From: Bill to Location’s/Individual’s Name - Name/Company_____ Street____ : 5...... .... .................. .. Street City/SvZp_. 4 -A__ L City/St/Zip........ ........... Identification of Source_ ________________ Phone#: ............. = .......... Fax #: Collection Point___ _________ ___ CA, CH, Bl?_______ Check#: Amounts

BACH OA—SKAl ANAlYS-LS ONGAMPriA/t ANAY: • OHANC NONTOIABL F /S1.0 ANALYE 5 Lab#:.__ _____________________ Lab# (circle tests) (circle tests) LOGAeEEs 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 f’/A (public supplies) 132 Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Conform MPN (priv well, raw. stp) 4. Total Trihalomethane Potential (510) 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 [7.1 Pesticides/PCB screen (508) ' 7. Herbicides (SM-18/6640; 8151) 7.APW 8. PCB as Decachlorobiphenyl (508A) 8 Other Pesticides (SM-18/6630) -Others 9. Herbicides (515) (10, Pesticides (525) 9. Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water Memoerated? yes no IT. 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 Chlorine Res; . ....... ; ■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)

( y **, .AMI' A.02"/SHGULSTFD-f : ■ / (circle tests) . Color d 20.Acldily 39. Aluminum 4r* _ 3as5 59. Potassium 12.5 Turbidity 0 :24. Alkalinity, as CaCOs (40. Antimony / * > 60. Selenium

3 PH 4. Conductivity a 23. Bromate/Ch lorate/Chiorite 42.Banum 22. Bromide 41. Arsenic 61. Silver 62, Sodium 5. Corrosivity (temp:........ _ "C) 24. Chloride £3. Beryllium 63-Thallium iemeemioeu C. BOD (5 day) .25.-Cyanide 44. Boron (§4,-Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. _________ 8 Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO2 46. Caicium, as CaCO3 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 , 43. 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, Totlf Kjeldahl as N (50./Cobalt 6.* Pethio-d-si ‘ . 13. Solids. Percent (%) 32. Oil and Grease 51. Copper 70 1 k ! olpal lo ■ - 33, Phenol 53.Leads 4. Solids, Settleable 52.Iron 71.TCLP-Metals TCLP □lids. Suspended olids. Total 36. Sul f ates e' ' — .54. 55. Magnesium dvr 34. Phosphorus, T otal as P

Manganese 35. Phosphorus, Ortho as P A 1o I’ ! der / iQPHerbijet, Surfactants. 157 (19 Other en1ate 37.38.UV254mzdanraas 17. Solids, Total Dissolved 518. Solids. Total Volatile 56.Mercurynhgsednes Molybdenum A /4 iC f VoU.I-r. 7, IGPBNA w58. Nickel aaso NYC-WTC_000027069

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NYC-WTC_000027069Source: NYC Law Department, mirrored locally

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