Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH £ 2 Dana Road, Valhalla, New York 10595 Ulestchester County (914) 593-5575 NYS-ELAPNo. 10V @ne/DateSet:_____ ____________________ ... . . Form A-70 (rev. 1/96) Sample Type (circle one): p F E < 601/ t I c 4?) t -«011, k 2r / ‘7 S K1 /C 1. Potable J 3. Non-Potable Treated PBoo «G3 04658,09837, c8F7 2.Non-Potable 4. Other____________ _ - Chain of Custody?___ yes___ no ~2s,- AUse Time/Date Collected:. Get/c / Comments: ) ) - Collected By:. . . NJArMAs Agency Code: • PWS #: .Source ID: Type Descriptor:. Collected From: Bill to: Location’s/Individual’s Name. NY C ( e P _ • Name/Company. • }

Street + I \ j +* ■ L. 1 1 ve Street_______ HA t I H . N . h: 2 (| — City/St/Zip. City/St/Zip . identification of Source__________ _ Phone#: Fax#: (^-Collection Point CAT LEFF CA, CH, BI? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ Lab #: / Ii (circle tests) (circle tests) i 1. Heterotrophic Plate J. Trihalomethanes (524' 1. Purgeable Halocarbons (624/8260) Count (hempdialysis & all others) .22 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 ( 2> Pesticides/PCB screen (508) 7 Herbicides (SM-18/6640; 8151) f (D° 7. API her: Refrigerated? yes no 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) C10. Pesticides (525) 11. Carbamate Pesticides (531) 8Other Pesticides (SM-18/6630) Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water 11. Acid Extractables (625/8270) 12. Glyphosate (547) 1.2. Base Neutral Extractables (625/8270) Chlorinated?: yes no 13. Diquat (549) C13.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#:. i (circle tests) 1 V/ 1. Color 20. Acidity 39. Aluminum *) 59. Potassium 2. T urbidity 21. Alkalinity, as CaCOs C40.-Antimony A 60. Selenium • 3. pH 22. Bromide 41. Arsenic 1 • 61. Silver A Conductivity 4. 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.anadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 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 (0. Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables g Solids, Settleable 33. Phenol 52. Iron TCLP V. 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 <19.9ther: 1 JT I 38. UV254 57./Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000027596