Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

IL ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 1/96) Gple Type (circle one): r /S ? I 1. Potable 3. Non-Potable Treated Bottle #‘s:/64 / 3 /

2. Non-Potable 4. Other_____________ Chain of Custody? .yes no s-20 (73,074 Time/Date Collected: I f ) f. "St A Comments: Collected By:. Collected From: C, Al, „ ft e Agency Code: PWS#:_____________ .Source ID:_______ Type Descriptor:. Bill to: Location’s/Individual’s Name_ AN Name/Company______ Street ______________ Street______________ _ _______________ Identification of Source _____________ Phone#_= Fax #: Collection Point, 42 ?<\% CA, CH, Bl?. Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:__________________ _ Lab #:_____ 7 / 7 I 0 (circle tests) (circle tests) — "I — / T 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) 0 Volatile Halocarbons (524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) n >.

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 1 Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) t 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 1 7. API 8. Other:___________________ Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Mgotatad? Pesticides (525) 10. Glycols in Water yes no 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:. 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. ____________________________ _ "___ INORGANIC ANALYSES REQUESTED - Lab#:. va Y Mri P i S ; C < *

h/ • (circle tests) L • 24. 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. T urbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chiorite 42. Barium 62. Sodium 5. Corrosivity (temp: .°C) 24. Chloride 43. Beryllium 63. Thallium i 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) 27. Hardness, Total as CaCO3 46. Calcium, as CaCOa 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 14. Solids, Settleable 33. Phenol 52. Iron TCLP @olids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals rrolids. 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 ad _otndlL NYC-WTC_000027195