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Document / 8 pages

Chain of custody record, Westchester County Labs, Oct 2001

Machine-extracted title · confidence 90%

Document tracking the transfer of environmental samples to the Westchester County Department of Labs and Research.

NYC-WTC_000027641–000027648

Folder label: “24694

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Scanned page image, NYC-WTC_000027643
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NYC 9/11 Public Portal Document

09 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster iv.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 (/Date Set: NYS-ELAP No. 10108 Form A-70 (rev.1/96)

Sample Type (circle one): 66447. 6924 696.0267 s3/ (1. Potable 3. Non Potable Treated . „7825, Bottle *Si C 973 98-::42667272 9964 -- --------------------------------------- 2. Non Potable 4. Other- Chain of Custody? yes no Time/Date Collected: /o-o 9-0 / 08/0 Comments: Collected By: C’ Agency Code: _ Source ID: Type Descriptor Collected From: Bill to: Location's/dividual's Name _ QA Name/Company _ Street_________________________ Street________ City/St/Zip ______ _______________ City/St/Zip_____ Identification of Source' -__________ DeP* Phone#:______ Fax#: Collection Point 4- /.SQ .30734 CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________________ Lab#: (circle tests) ))11 / / U 1^1 (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) 2 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6, Pesticides (507) 6. PCB’s (Arochlors) (608/8081) Scroscopig 2 Pesticides/PCB screen (508) 7. Methoprene (616) 4 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other__________________ 9. Herbicides (515) . 9. Pesticides (SM18/6630) (0 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Glycols 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) (4.GC/MS Semivolatile Unknown Scan 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res: mg/L 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF) 18. Other_______________________ 18. Other t

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 21. Alkalinity, as CaCO3 39. Aluminum 40. Antimony =Moak 59. Potassium 60. Selenium / > — 2. Turbidity 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 44. Boron 63. Thallium 6. BOD (5 day) 25. Cyanide 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 CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47.Calclum, 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-violatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobalt 69. Pesticides/PCB’s 13 Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables (Solids, Settleable 33. Phenol 52. Iron 53.Lead TCLP 15. Solids, Suspended 34. Phosphorus Total as P 54 Magnesium 71 .TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 36. Sulfates 55 Manganese 72.TCLP-Pesticides 17. Solids, Total Dissolved 73.TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 38. UV254 57 Molybdenum 74. TCLP-Volatiles 19. Other________________ 75.TCLP-BNAs 58. Nickel sutesats . ■. ■ .■ hass 44 t NYC-WTC_000027643

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NYC-WTC_000027643Source: NYC Law Department, mirrored locally

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