Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WES THCSTER COUNTY LABORATOPIS AND Ri st ARCH 2 Dana Road, Valhalla, New York 10595 **//**t% **tv —(914)593-5575 NYS-ELAP No. 10108

gne/DateSet_ _ ___ ___ —______ ______ _____ Form A-70 (rev. 1/96) sample Type (circle one): 7 ALHCRFBM/EBO.NBUV ′ '1. Potable J 3. Non-Potable Treated Bott le #s CA C? kb, J X ( hzi, • 1: 2, ( v t 5 Chain of Custody’’ __ ___ yes_____ no — : tov , 4 - 1 1 41 2. Non-Potable 4. Other_ Time/Date Collected:__ ■ em Comment s —yiii ===========-Ki Collected By:____ :... _ Agency Code:_____ PWS #:__ Source ID:______ Type Descriptor:___ Collected From: - Bill to! stredwestLALEDHIem Location’s'Individual’s Name__ .* Se...._____ __

Crty/SVZip_Y * 1 A Ud 12 N....1' 42 N a m e/C o mp a n y Street City/StZip___ Identification of Source............. ......... ......... ...... ..... .............. Phone#: Fax± [ CA, CH, Collection Point A (h Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGAN’:: " u AHt 1 ANA: Yf : ■ • *"A4490 NONPOTA(1£/$25 ANAI YSFS Lab# Lab* . d(circle (circle tests) tests) Tiemee 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 P/A (public supplies) 13. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) | 3. Coliform MPN (pF well, raw, stp) 4. Total Trihalomethane Potential (510) 4. rnthalates (606/8060) | 4. Pecal Coliform rail samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) i 5. Microscopic 6. Pesticides (507) " 6. PCB’s (Arochlors) (608/8080) | 6. Macroscopic (7 Pesticides/PCB screen (508) 7: Herbicides (SM-18/6640; 8151) 1.) ZAR 8. PCB as Decachlorobipheny! (508A) 18. Other Pesticides (SM-1 8/6630) ther 1.9. Herbicides (515) 10. Glycols in Water _ (10. Pesticides (525) ‘’9. Petroleum Hydrocarbon Scan (310-13)

Refrigerated? .... __yes_. __ no 11. Carbamate Pesticides (531) - 11. Acid Extractables (625/8270) '

Chtornated?: yes ....... no 113. Diquat (549) 12. Glyphosate (547) ee 14. Chlorination Disinfection Byproducts (551) 12 Base Neutral Extractables (625/8270) ’ (13 GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) Free Chiorne Res: _mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: mng/L 17. Petroieum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

_PH —U "tri (circle tests) ArAtY. 5 H! (ti Sl D eg l : AlOsaln 1.Coor 2. Turbidity 3H 4. Conductivity 20. Acidity 21. Alkalinity, as CaCO3 22. Bromide 23. Promate/Chlorate/Chlorite 39. Aluminum (40: Antimony 41. Arsenic Barium 59. Potassium 60. Selenium 2 61 Silver 262/Sodium B 5. Corrosivity (temp: _ °C) 24. Chloride Beryllum-l 63 Thallium i 6. BOD (5 day) 7. Soluble BOD (5 day) 25. Cyanide 26. Fluoride 44. Boron 45. Cadmium -% .64. Vanadium — 65. Zinc_______ ”2 Calcium, CaTotal 47.48. Chromium, CLP ’ ” 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10. Dissolved Oxygen 27. Hardness, Total as CaCO3 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N 4(5. Calcium, as CaCOa :66.Metals/CN 167. Volatiles 11. Total Organic Carbon 12. Total Organic Halides 30. Nitrogen. Nitrite as N 49. Chromium. Hexavalent 31. Nitrogen. Total Kieldahl as N./5051.. Cobalt d 68.Semi-volatiles 69.Pesticides/PCB‘s Copper g' 13. Solids, Percent (%) 33 Phenol sd 52.53. ILead ron - 32. Oil and Grease . 70. Disk Deliverables TCLP d Solids Total 16. ) 34. Phosphorus. Total as P ' 54. Magnesium 17. Solids, Total Dissolved 36. Sulfates sece 55. Manganese 35.' Phosphorus, Ortho as P ■1 4.71.TCLP-Metalss 172.TCLP-Pesticides 73.TCLP-Herbicides L18, SOtolhiergusa 119 ds, Lotal Volatileand 38UV254s 37. Surfactants— 56. Mercury . (57, Molybdenum 4874.TCLP-Volatiles 75.TCLP-BNA‘s 458. Nickel h NYC-WTC_000027250