Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document MEs hrenmd ENVIRONMENTAL SERVICES SAMPLE KUdMISSION FORM

880 Ag2ana WESTCHLSTER COUNTY I ABORATORRS AND Br RRcH Road, Valhal a, New York 10595 266* _ta141593-5575 NYS-ELAP No. 1

MgsoaA .89.k7,8357/ Time/Date Set:_________ ______ ____________ ____ ■ ___ __ __ _____ ____ Form A-70 (rev. 1/9., ■

Sample Type (circle one) - 1. Potable 4 3. Non-Potable Treated Bottle wsMOReLeikc 2.Non-Potable4.Other_ Chain of Custody?_ :__ yes____ no Ron/ez/K h cLl Time/Date Collected: T Col ected By P.ci Cel,, 2-* : rout. Agency Code:, _ C8e****

PWS*_ Bill to =- _ Source ID'_______ Type Descriptor: __

i 7. Location's/Individual's Name__ 4 Name/Company_ Street_____ al st_ = X I Street___ . _____ City/St/Zip____ = A i___ 4 nvdie Citv/StZip Identification of Source__________ Phone#: —Fax# Collection Point. LO&A [CA CH. BP Check# h Amount?

iW: IC1UGAA) ANALYk S ORGANIC POTABLE ANALYSES -*,a87C NQNT‘G37A.s5 . :‘(*f ri XHA6SS La# Lab# S(circle tests)—ANsE .(circle tests) G T. 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 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 (ail samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5.6. Microscopic Macroscopic = -------- 6. ( 7) Pesticides (507) Pesticides/PCB screen (508) 6. / PCB’s (Arochlors) (608/8080) : I : sr (M 1apa0: apt) 7.API_ 8.Other 9., Herbicides (515) mem 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) y. Fetroieum Hydrocatbon Scan (31u-13) ,

Refrigerated?_____ yes_____ no (10) Pesticides (525) ----- ‘11: Carbamate Pesticides (531) 10. Glycols in Water 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chionated?: .yes_____ no 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) 13. GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) Free Chionne 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)

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INORGANIC ANALYSES REQUESTEDLab#: (circle tests) a 1. Color 2. Turbidity 20. Acidity 21. Alkalinity, as CaCO3 39. Aluminum (40. Antimony " MeS f ' 59. Potassium 60. Selenium 3.4. pH Na Conductivity 22. Bromide 23 Bromate/Chlorate/Chlorite 41, Arsenic 42. Barium 61. Silver i 62, Sodium: / 5. Corrosivity (temp; _°C) 24. Chloride 43, Beryllium /63. Thallium /64.anadium 6. BOD (5 day) 25. Cyanide 44. Boron 7. Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 26. Fluoride 27. Hardness, Total as CaCOa 45. Cadmium 46. Calcium, as CaCOa 65. Zinc I ' CLP . 1 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca* 66. Metals/CN 1 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 0. Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. 011 and Grease 51. Copper - 70. Disk Deliverables 1 14. Solids, Settleable 33. Phenol e 52.Iron TCLP 15. Solids, Suspended 53.Lead—ietls 34. Phosphorus. Total as P .'1 IMMu* 16. Solids, Total

18. Sol i ds. Total Vol a ti 117. Solids, Total Dissolved l e ‘ Sulfates-===- 56, Mercury MG 36.37.Surfactants 35. Phosphorus, Ortho as P 54. Magnesium 55. Manganese ‘ i c P Pa twaldjo , 1 rtl P I i. i '<■,

119OtherSzobn 38.UV254d (57. Molybdenum "5 158, Nickel 74. TCLP-Volatiles /s HP INA ,

NYC-WTC_000027167