Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM (4 1i i).: i WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 _s(914) 593-5575 Pis i i AP No* H; mn Time e/Date Set: . a:m A 70 (av 11* ) P de Sm pie Type (circle one): C47‘ ft

Bottle #‘s: , A - s Citno: > Ap*d ‘I ■ 1. Potable ■ 3. Non Potable Treated 2. Non Potable 4. Other_____ _............ • Chain of Custody?___ yes _...._ no Time/Date Collected:iL ■ Comments: Collected By: ‘ _ Agency Code:. PWS #:____ _ Source ID: _.... ...... ... Type Descriptor: _ * Collected From: Bill to: . ... ... ;} Location’s/Individual’s Name Name/Company Street........ '____ _ __ _ Street. _. .. 3 . • ** City/St/Zip___ __ _ _ City/SVZip____ identification of Source____ I Phone#; 9 . Fax#: _ Collection Point ___ _______ CA,CH, Bl? _ Check.--------- — Amount... —

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_____ ___________ _____ ____ _ -ab#: _..... ____ __ ____ J... I__ _A.... / ; (circle tests) (circle tests) . I 21 ‘ "i y 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 (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 7 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. RCB's (Arochlors) (608/8081) • Macroscopic 17) Pesticides/PCB screen (508) 7. Methoprene (616)

__ ________________ 8. PCB as Decachlorobiphenyl (508A) 9, Herbicides (515) Pesticides (EPA1978/8151) —■8.9, Herbicides (SM18/6630) Refrigerated?___ yes no 10) Pesticides (525) 111. Carbamate — Pesticides (531) e 11. Glycols i hoeanHyossbontgm (010 i.s; 90/1140/ Chlorinated:? yes___ no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (549) 13, Base Neutral Extractables (625/8270) Free Chlorine Res: _ mg/L 14. Chlorination Disinfection Byproducts (551) 44GC/MS Semivolatile Unknown Scan 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res:________ mg/L

Scan (310-13) I =17.Pesticides/PCB‘s(DEF) 16. Pesticides (SM 18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon "18. Other Immmd 18. Other:....... .. ........ ....... .. ..... ...... ..... _

INORGANIC ANALYSIS REQUESTED - Lab#: __ (circle tests) yhvo /j5 W1, Color — 20. Acidity 21. Alkalinity, as CaCO3 39. Aluminum ( 40) Antimony 59. Potassium 60. Selenium : ‘ 2. Turbidity -3.DH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 42. Barium 2 23. Bromate/Chlorate/Chlorite 24, Chloride M (43 62. Sodium 5. Corrosivity (temp____ °C) 25. Cyanide Beryllium hpa 44. Boron 63. Thallium /64 Vanadium t 6. BOD (5 day) | 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium C 65. Zinc 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 27. Hardness, Total as CaCOs 28 Nitrogen, Ammonia as N 4 6. Calcium, as CaCOs 47. Calcium, Ca42 [CLP 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-violatiles 12. Total Organic Halides 31. Nemogor . i : : i . : ! 2 . . : 69. Pesticides/PCB's N7. Oil an < v* .i 51. Copper 1 Sold., H 0 a Solids, Settleable 33, Phenol 34. Phosphorus Total as P 52. Iron 53.Lead 0 i 'r N [* ict oh

TCLP Solids, Suspended 71 TCLP-Metals Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 36. Sulfates 55 Manganese 72. TCLP-Pesticides 17. Solids. Total Dissolved 73. TCLP-Herbicides | 18. Solids. Total Volatile 37 Surfactants 56. Mercury 19 Other Sthits 38.UV254d ( 57 Molvbdenum 74. TCLP-Volatiles A, GPamm ■

NYC-WTC_000027621