Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document ‘9*953 **

III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2'Dana Road, Valhalla, New York 10595 (914)593-5575 NYS-ELAP No. 10108 (e/DateSet:_____ 1. C Form A-70 (rev. 1/961 Sample Type (circle one): t 1. lsmooduie’ t 1 v t, v ' — I G Potable — 3. Non-Potable Treated Bottle #‘s: st • f t ’ , A L. 1 V 164 2. Non-Potable 4. Other___________ _ Chain of Custody? .yes .no Time/Date Collected:. »• 1-i t 0972- Comments: Collected By: V Aoencv Code: PWS #:___________ .Source ID:. -Type Descriptor:. Collected From: Bill to: Location’s/Individual’s Name. ths* vv . _ Street__________________ _ Street____________ City/St/Zip_______________ City/St/Zip_________ Identification of Source. • btPN Phone#:, Fax #: Collection Point. Issu . ■^QlbU ’ CA, CH, Bl?, Check#: Amounts,

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_____________________ Lab#: ■ /2072 4 (circle tests) (circle tests) f ' /17 ) / / 1. Heterotrophic Plate 1 ’ 1 Trihalomethanes (524) * 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ‘20) 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) her:___________________ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) (10 Pesticides (525) 10. Glycols in Water Refrigerated? yes 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 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#: (circle tests) ... 1. Color 20. Acidity 39. Aluminum !; • , 559. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 4Q. Antimony * 60. Selenium 3. pH 22. Bromide 41. Arsenic ’ 61. Silver 82. Sodium 4. Conductivity 23. Bromate/Chlorate/Chlorite • 42. Barium 5. . Corrosivity (temp: °C) 24. Chloride . 43. Beryllium 63. Thallium 6..' BOD (5 day) 25. Cyanide 55" 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 CaCOs 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. Volatile,s 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-Volatiles 12. Total Organi 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 tSolids, Settleable 33. Phenol 52. Iron TCLP / CSolids, 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 I 74. TCLP-Volatiles \ 19. Other:_________________ 38. UV254 57. Molybdenum 75. TCLP-BNA's can 58. Nickel jd

NYC-WTC_000027361