Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

IN ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH £ 2 Dana Road, Valhalla, New York 10595 Ulestchester County (914) 593-5575 NYS-ELAP No. 10101 Cne/Date Set: ______ ___________ Form A-70 (rev. 1/96) Sample Type (circle one): Q q^co QC 80D1 C r e )/ KV50, K l2 (. Potable _ 3. Non-Potable Treated pottle #’s:PC 52 Fool, P£90P)) CQilo 2. .Non-Potable 4. Other___________— Chain of Custody?_____ yes no Time/Date Collected: - / 6 Comments: _____ . i Collected By: A.Nw/ Agency Code:. Type Descriptor: 70 ___________ Source ID: Collected From: < _— Bill to: , , Location’s/Individual’s Name. NMCOE P / Name/Company. Street it V *+ LAIE I r IE_______ Streets______ City/St/Zip v ■ ft ri H L i 0 V *(, :0 - City/St/Zip Identification of Source___________ __________!________ Phone#: Fax#: Collection Point. C O C• .... .. P CA, CH. Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: __________________ Lab #:____________________________ (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 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) 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) 8. Other Pesticides (SM-18/6630) zAPL . ______________ ' (Other 8. PCB as Decachlorobiphenyl (508A) 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) (13GC/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 ( < /d6759. Potassium 2. Turbidity 21. Alkalinity, as CaCO3 (40. Antimony ya - — 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, Hexavialent 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 ( Solids, Settleable 33. Phenol 52. Iron TCLP " 45. 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: n Ti 38. UV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel '

NYC-WTC_000027598