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Chain of custody record, Westchester County Lab, Oct 2001

Machine-extracted title · confidence 95%

Document tracking the custody and handling of environmental samples submitted to the laboratory.

NYC-WTC_000027247–000027251

Folder label: “24233

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NYC 9/11 Public Portal Document

III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WEST CHES TR COUNTY L ABCRATORIS ANP RESMARCH 2 Dana Road, Valhalla, New York 10595 Uestchester County 914 593-5575 G NYS-ELAP No. 10108 ane/Date Set: Form A-70 (rev. 1/96) Sample Type (circle one): oAldb.AFB22E6039,k6266m 1Potable 3. Non-Potable Treated Bottle * ‘s± N-20 76 25 T __ _____________ 2. Non-Potable 4. Other. Chain of Custody? _ __yes__ Ino K‘781 87oli b t. Time/Date Collected: 20O D-9l__ Comments:... ___________________ __ Collected By_2.2 » FT Acency Code:___ PWS #: Source ID' Type Descriptor: Collected From: .. i ■ ****// T L oc a t i o n ’ s /1 n d iv id u a'' s N a me_ L L Name/Company, _ Street_ __s __ ___ L Street___ City/StZip. / /s NY City/StZip identification of Source . Phone# Fax # Collection Point t / f | CA, CH, Bl? Check#: Amount?

A f- i "Bit As ANALY6 5 OReANK Pt ‘ Aii l AN*) Yi : (44.4 talr Nt »NP( H A;;| « )i.i[) ANALY3.S I Lab#:mntl (circle tests) LabIe ((circle lests) s 1. Heterotrophic Plate 1„ Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ?2.i Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) . ? CoMorm P/A (public supplies) 13/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) . : | 3 Coliform MPN (prv well, raw, stp) 4. I otai Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (ail samples) 5. Microextractables (504) . 5. Organochlorine Pesticides (608/8080) / 5. Microscopic 6, Pesticides (507) 46: PCB's (Arochlors) (608/8080) : 6. Macroscopic (7) Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7 API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) ae " Refrigerated?_____ yes........ no 9. Herbicides (515) (10. Pesticides (525) 11. Carbamate Pesticides (531) —10. Glycols in Water = 9. Petroleum Hydrocarbon Scan (310-13)

.11. Acid Extractables (625/8270) i

! Chlonnated”: _ yes_____ no _ _ w_.. CSE.GQ/MS Unknown Scan s 12. Glyphosate (547) 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) _ 12 Base Neutral Extractables (625/8270) ': 14. Purgeable Halocarbons (DEF) F roe Chionne 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)

■ •* ■ ? *‘. **A Yi 5 Hl i -Ur *!t it . (circle tests) MW J . 39. Aluminum .—COOpCeee 20. Acidity 59. Potassium

I 2. Turbidity 22. 21. Alkalinity, as CaCO3 (.40? Antimony 60. Selenium? 3HE Bromide 4 1. Arsenic 61. Silver I 4. Conductivity 5. Corrosivity (temp:____ _OC) 23. Bromate/Chlorate/Chlorite 24. Chloride . 42. Barium_ (43.)Beryllum9 62. Sodium ’ (63Thallium 1 I

6. HOD (5 day) 25.Cyandet 44. Boron r (64. Vanadium 55 7 Soluble BOD (5 day) i 26.Fluondee9 46.Calcium,asCaCOa 45. Cadmium 65. Zinc CLP_L ft. Carbonacecus BOD (5 day) 9. Chemical Oxygen Demand 27. Hardness, Total as CaCOa

Nitrate 28. Nitrogen, Ammonia as N 29. Nitrogen, as N 47.48.CChromi ”? alcium,um,CaTotal e 67.68.Semi-volatiles Volatiles " 66. Metals/CN 10. Dissolved Oxygen 30. Nitrogen, Nitrite as N 149. Chromium, Hexavalent Cobalt smass " 650 11. Total Organic Carbon 12. Total Organic Halides 13. Solids, Percent (%) and Grease 32.33.P011henol 31. Nitrogen, Total Kjeldahl as N 51. Copper M 52. Iron 10107 69. Pesticides/PCB’s 70. Disk Deliverables TCLPde se 1 34. Phosphorus. Ortho Total asasP "53.Lead"Ppe 71.TCLP-Metals 16. Sol i d s, Tot a l —msp 35.Phosphorus. 117.Solids, Total Dissolved an 36,Sulfates ■ P. 54. Magnesium “55. Manganese e 72. TCL P-Pesticides

118. Sol (9oter“Tii ds. Total Vol a t i le ann 37. Surfactants 38UV254 “(5756., Mercury eee Molybdenum _ $74.TCLP-Volatiles 73. TCLP-Herbicides

/b T< ! I’ NNA" 158. Nickel tet NYC-WTC_000027249

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NYC-WTC_000027249Source: NYC Law Department, mirrored locally

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Westchester County Department of Labs and Research chain of custody form documenting the transfer of environmental samples.

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