Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document ‘ . ,*"*** .

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH US 2 Dana Road, Valhalla, New York 10595 Wegchestercouny (914) 593-5575 NYS-ELAP No. 10108 “e/Date Set: Form A-70 (rev. 1/96) Sample Type (circle one): 7/87. e 22 6647, C 4942., 5 «} 0930, 8627. 924.. 9 2 e.) (1.) Potable 3. Non-Potable Treated Bottle #’s:____________________________________ _______ 2. Non-Potable 4. Other_______ _____ Chain of Custody?_____ yes .no Time/Date Collected: /o-7-0 / 0737 Comments:_____________ Collected By: C • TS & *______ Agency Code:. _ .Source ID:, .Type Descriptor:. Collected From: , Bill to: Location's/Individual's Name. BK Name/Company, Street__________________________ Street________ City/St/Zip______________________ _ Identification of Source _ ________ DP# Phone#: Fax#:, Collection Point. 22960 3072 1 CA, CH, Bl? Check#: Amounts. ‘i a _ *. BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ (circle tests) Lab.:---- 2 (circle tests) 417 ^7I lI " 02 / / 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 Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 5 (10. Pesticides (525) 10. Glycols in Water Refrigerated? „es no 11. Carbamate Pesticides (531) 12. Glyphosate (547) 11. Acid Extractables (625/8270) &‘ Base Neutral Extractables (625/8270) . Chionnated?: yes no 13. Diquat (549) I. 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#:. (circle tests) l< ; 5 1. Color 20. Acidity 39. Aluminum 59. Potassium;;. , ** 2. T urbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium I f l i * 1.," 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 i 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc ■________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs 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 1@Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables Colids, Settleable 33. Phenol 52. Iron ISLP 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:_____________ 38. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000027645