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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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NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH com 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 @e/Date Set: NYS-ELAP No. 10108 0346, Y- / 64592479rev.1/96) Sample Type (circle one): b. Potable 3. Non Potable Treated s 42016,001" Bottlers.- -‘‘Ui 1________________________ 2. Non Potable 4. Other___________ Chain of Custody? yes no Time/Date Collected: . • li :- * Comments: Collected By: f Agency Code: _ Source ID: .Type Descriptor Collected From: Bill to: Location’s/ndividual’s Name. lruavll/ic” Name/Company _ Street________________ Street________ City/St/Zip_____________ City/St/Zip Identification of Source * Phono#:______ Fax# Collection Point t-A . CA.CH, Bl? Check#: _ Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS / ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________________ Lab#:------ -- / J (/C (circle tests) (circle tests) - / (f | 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) P*) 3. Coliform MPN (priv well, raw, stp) > ... 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) .2 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) @croscopic ( Pesticides/PCB screen (508) 7. Methoprene (616) Wl 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151)' . 3 8. Other__________________ 9. Herbicides (515) 9. Pesticides (SM18/6630) (0, Pesticides (525) Refrigerated? yes no 11. Carbamate Pesticides (531) 10. Petroleum Hydrocarbon Scan (310-13) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (549) 13Base Neutral Extractables (625/8270) 9 Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) (14/GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Adds (552) 15. 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) Mtalo at 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium’ 3. pH 4. Conductivity 22. Bromide 23. Bromate/Chlorate/Chlorite 41. Arsenic 42. Barium 61. Silver 62. Sodium ; It’ 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 CaCOs 28. Nitrogen, Ammonia as N 47. Calcium, Ca+2 E6"Metals/cN 9. Chemical Oxygen Demand 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.Pesticides/PCB‘s 13Solids, 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 35. Phosphorus, Ortho as P 54 Magnesium 71 TCLP-Metals 16. Solids, Total 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 37. Surfactants 56. Mercury 73.TCLP-Herbicides 18. Solids, Total Volatile 74. TCLP-Volatiles 19. Other:________________ 38. UV254 57 Molybdenum 58. Nickel 75.TCLP-BNA’S ___ - ■ --S-a-=--- . -. „_ticltnaskiacddas - NYC-WTC_000027648

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NYC-WTC_000027648Source: NYC Law Department, mirrored locally

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