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Document / 8 pages

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_000027271–000027278

Folder label: “24287

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Scanned page image, NYC-WTC_000027276
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NYC 9/11 Public Portal Document "Lereegan oameoastvsenterts tyngrn veszttcometrpdt.stsswuttwatnne) "' PFU ’ zarse r r** -=aorw=p=t

m Time/Date Set:_________ Sample Type (circle one): ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575

:

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• , NYS-ELAP No. 10W Form A-70 (rev. 1/96) 11 .

1. Potable . 3. .Non-Potable Treated Bottle #s:GI e ,, *Sh-01 2. Non-Potable 4. Other_____________ Chain of Custody? yes .no Time/Date Collected:. 21 0S8 Comments: Collected By: Varss .Agency Code:. PWS#:__________ .Source ID:. .Type Descriptor:. Collected From: Bill to: Location’s/Individual’s Name. 84 e-t*pp ", Name/Company___ Street__________ _______ Street___________ City/St/Zip_______________ dky/SVZip Identification of Source • . 0 P 4 Phone#:, Fax # Collection Point 30020 CA, CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES. A ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_________ — Lab,*:--------- — L 0 I (circle tests) (circle tests) 'A i V 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) 1. Heterotrophic Plate 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 (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) - 5. Microscopic 6. Pesticides (507) 6. 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) 8. Other: . 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) (10. Pesticides (525) 10. Glycols in Water s" Refrigerated? ves_____ no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12 Base Neutral Extractables (625/8270) Chlorinated?: yes no 13. Diquat (549) (13 GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free 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)

pH ana

--------------------------- * 4 :----- INORGANIC ANALYSES REQUESTED? Lab#: (circle tests) ! 4 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. AJkalinity, as CaCO3 40. Antimony 60. Selenium .) 3. pH 22. Bromide 41. Arsenic 61. Silver C2 w • -es 4. Conductivity 23. Bromate/Chiorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: .°C) .24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 7. Soluble BOD (5 day) 25. Cyanide 26. Fluoride 44. Boron 45. Cadmium 64. Vanadium 65. Zinc iI 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 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 15. Solids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. Solids. 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-Volatlles 19. Other:_________________ 38. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel ads ssabdddat= . NYC-WTC_000027276

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