Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document erypotyu

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

IU stchester County ie/Date Set: WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 $

NYS-ELAP No. 10108 Form A-70 (rev. 1/96)

Sample Type (circle one): 240., " . 5 1. Potable ” , 3. Non-Potable Treated P Bottle #'s:______________ 2."Non-Potable 4. Other_...... ...... .. — Chain of Custody?_____ yes no ) * Time/Date Collected: 0 > / 70 ?------ Comments:. , - Collected By: /A • kam__ Agency Code: PWS # Source ID: Type Descriptor: Collected From: . Bill to: }

Location’s/Individual’s Name 1*YL * L i Name/Company. Street ri den t S H + x1/e_ Street________ City/St/Zi \ H -AHi it )v H 51- City/St/Zip Identification of Source . _ ________ Phone#: Fax#: i -Collection Point. . 8 ' ( • CA, CH. Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_______________________ Lab 100 (circle tests) (circle tests) . | ‘ : ) 1. Heterotrophic Plate 1. Trihalomethan es (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 4 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)

GP: __ ________________________ 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 10/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) Chlorinated?:____ yes no 13. Diquat (549) (3GC/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 1 A. 7 59. Potassium ; 2. Turbidity 21. Alkalinity, as CaCOs C40.Antimony AC 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 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 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 Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 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-Volatiles 19 other oi 38. HV254 .57. Molybdenum 75. TCLP-BNA’s K 58. Nickel

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