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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_000027647
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NYC 9/11 Public Portal Document re­

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM seer WESTCHESTER COUNTY LABORATORIES AND RESEARCH vcom 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 •mm @eD ate Set: C. »— . 2.4, , . fz T' /; NYS-ELAP No. 10108 Form A-70 (rev.1/96)

Sample Type (circle one): g,90i1/20022---------- Bottle22592 .893 ,7___________ 1. Potable 3. Non Potable Treated 2. Non Potable 4. Other ________ ___________ Chain of Custody? yes no Time/Date Collected: / ' 7 /C / $1 P Comments: Collected By: / / 67 (Ao //A Agency Code: PWS#:_______ source ID: .Type Descriptor Collected From: Bill to: Location’s/dividual’s Name ■ ' C "e • Name/Company Street_________________________________ _________ Street________ City/St/ZIp________________________________________ _ Identification of Source' + ________________________ Phone# _ _____ Fax# Collection Point //U8 --------------------------------- CA.CH, Bl? . Check#: Amounts. 454 BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS — ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________________ (circle tests) 1. Heterotrophic Plate C4VT 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) pt 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 55 5. Microscopic 6. Pesticides (507) 6. PCB's (Arochlors) (608/8081) . Scroscopig ( Pesticides/PCB screen (508) 7. Methoprene (616) 4 V, 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) — 8. Other:__________________ 9. Herbicides (515) 9. Pesticides (SM18/6630) - 10) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) . Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 12. Add Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 14.GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 157 Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other_______________________ 18. Other___________ _____________

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum al 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver • r 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium ’ I 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 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-violatiles 12/ Total Organic Halides 31. Nitrogen, Total Kjeldahl as N SO.Cobalt 69. Pesticldes/PCB’s 13.Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables Colids, Settleable 33. Phenol 52. Iron TCLP 15. Solids, Suspended 34. Phosphorus Total as P 53.Lead 54 Magnesium 71 TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 55 Manganese 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 56. Mercury 73. TCLP-Herbicldes 18. Solids, Total Volatile 37. Surfactants 19. Other________________ 38. UV254 57 Molybdenum 74. TCLP-Volatiles 75.TCLP-BNA’S 58. Nickel --- Bnssan NYC-WTC_000027647

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NYC-WTC_000027647Source: NYC Law Department, mirrored locally

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