Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

H hocty ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 5 : oai >; J) WESTCHESTER COUNTY LABOR AT OnEs AND RESEARCH H R-002DanaRoad,Valhalla,NewYork10595 914 5935575 MYris I AP N 10106 Time/Date Set: -Form A-70 (rev. 1/00

Sample Type (circle one): C-9192 *-7089, 2695 5 17 £ / P 41 » . „1 ; a= (555.177 "074, 1. Potable • 3. Non Potable Treated Bottle #'s. _ *1y/_ J .1' IJ •' . 2. Non Potable- 4. Other________________ __ ______ . Chain of Custody?___ yes____ no Time/Date Collected:_ LIS_ _______________ Comments:____________________ - ------------------ Collected By:_ 2Ala<adal Agency Code:... PWS # Source ID: _ ..... ..Type Descriptor: .....

Collected From: Bill to: Location’s/Individual’s Name........AYA == -44-A — * 16" '■ Name/Company _ Street__ e / / A. - ' Street______ City/StZip .... _ 2‘ ‘Ai4-A. rjv es City/StZip_ ___ : ... Identification of Source m—a/9/amaai Phone#: _ Fax#:...... Collection Point______ e.2 CA.CH, Bi? ___ Check#: _ Amounts. _

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:__ __ ________ __ _________ Lab#: 1 •) (circle tests) / / (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) ‘ 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) /2x 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, sip). 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) / 6. Macroscopic (7! Pesticides/PCB screen (508) .API 8, Other:___________ _______ ___ _ 8. PCB as Decachlorobiphenyl (508A) 7 Methoprene (616) .8. Herbicides (EPA1978/8151) 9. Herbicides (515) 9. Pesticides (SM18/6630) (10) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated?yes___ no

Chlorinated:? _... yes.... _ no Tl. Carbamate Pesticides (531) 12. Glyphosate (547) 11. Glycols 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 (SMI8/6630) 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) (dalo 1.2. Turbidity Color "0 20. Acidity- 21 . Alkalinity, as CaCO3 39. Aluminum 40. Antimony 59. Potassium 60. Selenium 3, pH 22. Bromide 23. Bromate/Chlorate/Chlorite 41. Arsenic 42. Barium 61. Silver 62. Sodium 4. Conductivity 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 28. Nitrogen, Ammonia as N 46.Calcium, as CaCOa 47. Calcium, Cat2 _CLP 9. Chemical Oxygen Demand 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 51.Copper 13.Soids,Fercent (7o) 14. Solids, Settleable 32. Oil an Grease- 33. Phenol. 52.Iron 53.Lead_ —TCLP 70. Disk Deliverables

Solids, Total 15. Solids, Suspended 16:7, Stes fdd 34, Phosphorus Total as P 3'> Pl al w/ । • I’ 7TCLP-Metals 54 Magnesium ? I i: 1" lieH.- 55 Manganese 18, aboonsoived atile m Solids, Total Volsuis 37, Surfactants - 36. Sulfates 56. Mercury / GHkbire 19. Other 38.UV254 58. Nickel see 57 Molybdenum / IIP Yoatieo /.IoLNAS

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