Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

- a JU ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 t v \ . 557 (914) 593-5575 y. 44< 6e0 NYS-ELAP No. 10108 XDate Set:_________ _____ ae8 / Form A-70 (rev. 1/96) ple Type (circle one): p. 040.1-1x Bottle #’s: 0.0161 . ‘ _ ________________________ 1.Potable 2. Non-Potable — 31 Non-Potable Treated 4. Other I I __ n Chain of Custody? yes no \o\s\Q, Time/Date Collected:__ . 16, 6 Comments: Collected ByiBoodddkgency Code:____ _ .Source ID:, .Type Descriptor:. Collected From: . 1 - Bill to: Location’s/Individual's Name* WW4 * Name/Compahy Street 44 Street__________ City/SuZip. City/St/Zip______

Dhr.* Identification of Source • Collection Point . /* Phone#_ CA, CH, BI? Check#: Fax#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:__________ ____________ Lab#: (circle tests) 4 1 14.L0/ (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1 ' 1. Purgeable Halocarbons (624/8260) 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) Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Macroscopic D Pesticides (507) Pesticides/PCB screen (508) 6. PCB’s (Arochlors) (608/8080) 7. Herbicides (SM-18/6640; 8151)

Ger______ 7. AP! 8. PCB as Decachlorobiphenyl (SOSA) 9. Herbicides (515) 40. Pesticides (525) — 8. Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) 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) r a (37GC/MS Unknown Scan Chlorinated?: yes no 13. Diquat (549) » 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 testa)' *< • t 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/Chlorite " 42. Barium 62. Sodium 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 63. Thallium 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 CaCOs 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. 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 1golids, Settleable 33. Phenol 52. Iron TCLP 1blids, 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-Volatiles 19. Other_____________ 38. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000027363