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Chain of custody record, Westchester County Labs, Oct 2001

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Documentation tracking the transfer and handling of environmental samples between collection sites and the Westchester County Department of Labs.

NYC-WTC_000027531–000027533

Folder label: “24483”

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NYC 9/11 Public Portal Document

L gig ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■■■ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 4en _ 2 Dana Road, Valhalla, New York 10595 Mogghostar county </ P / We/DateSet: YL &0 / P7 j (914)593-5575 * " 2 1 _____________ * - / 7__________ NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Sample Type (circle one): d - 2+1 . 27 >,714,97*** 1. Potable

2. Non-Potable 3. Non-Potable Treated

4. Other Boni/23,54112,*142723,2656 Chain of Custody? ‘ ves_____ no ‘ Time/Date Collected:_____ _ A . Comments: Collected By: / / Ao .Agency Code:. PWS #:_______ .Source ID: .Type Descriptor. Collected From: Bill to: Location’s/Individual’s Name_ thALVLY Name/Company. Street____________________ Street________ City/St/Zip________________ City/St/Zip Identification of Source- __________ Phone#: —Fax #:. Collection Point BX 3 CA, CH, BI? Check#: Amounts - - 170177

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES i •. pros2 Lab#:__________ — Lab #:_______________________ (circle tests) I (circle tests) . .. . ar . 54 1. Heterotrophic Plate 1 Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) 3 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) t 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) .0 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) *. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 5. Microscopic 6, Macroscopic G Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) 7. Herbicides (SM-18/6640; 8151) < wees ■ ***-

S.r 9. Herbicides (515) 8. Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) *

10. Pesticides (525) 10. Glycols in Water Refrigerated? _______ no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chionnated?: .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) 5 s pH. • - 4 INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity all93 39. Aluminum 59. Potassium 2. T urbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium t 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 CaCO3 46. Calcium, as CaCO3 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 12. Total Organic Halides 30. Nitrogen, Nitrite as N 31. Nitrogen, Total Kjeldahl as N 49. Chromium, Hexavalent 50. Cobalt 68. Semi-volatiles 1:t 69. Pesticides/PCB’s 1anolids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables Nolids, 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-Volatiles 19. Other:• 38. UV254 57. Molybdenum 75. TCLP-BNA's ______ 58. Nickel ______ e sic ... _ A ...... ___2

NYC-WTC_000027533

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