Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

. ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM r . < er WESTCHESTER COUNTY LABORATORIES AND RESEARCH ' 2 Dana Road, 1Va4)lha593l a,-5575 _9 New York _ 10595/ NYSIAlNo 166 Time/Date Set: jnnnniio 19 = G .12 / ‘ /1K- (,7s ) - Samplyp " 1. Potable / 2 ) :3. Non Potable Treated f* 553, 213 1, 4-30,9? Bottle #‘s:_____ __ __ _ ________ 3,127, 8868- 2. Non Potable ' 4. Other Chain of Custody? . yes _..... no Time/Date Collected: . 10^6 tc. / / ( tents Collected By: /AleWAN Agency Code:___ PWS #_______ _ ___ Source ID: .Type Descriptor: Collected From: Bill to: . 220..,. Location’s/Individual’s Name NY( " "As ro n 5 Name/Company.............. Street ' 1 I < -J ■ TAk ,08 _ _ Street, _...... . City/SVZip _ Mae (.9 / . A _ A v / City/SVZip . .. Identification of Source ...____ ____ ___ : Phone#: ■ . . • Fax# Collection Point_______________ __ CA.CH, Bl? _ Check#: Amounts iiiiii

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANAIYSS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#: Lab# (circle tests) /— // 7,2/ / / /U (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) 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) . Macroscopic (J Pesticides/PCB screen (508) /APL_ 8. Other:........ . . .............. ............. . 8. PCB as Decachlorobiphenyl (508A) 7f Methoprene (616) 8. Herbicides (EPA1978/8151) 9. Herbicides (515) 9. Pesticides (SM18/6630) ' io) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? . ..... . yes.. ..... no

Chlorinated:?____ yes____ no 11. Carbamate Pesticides (531) 12. Glyphosate (547) 11. Glycols 10/0101 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:

INORGANIC ANALYSIS REQUESTED - Lab#:. (circle tests) 1, Color of 20. .Acidity 39. Aluminum 62 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3, pH 4. Conductivity 22.Bromide.gMe 23. Bromate/Chlorate/Chlorite 41. Arsenic 42. Barium 61. Silver 62. Sodium 5. Corrosivity (temp:_____ °C) 24. Chloride Mdme 25. Cyanide 43. Beryllium 44. Boron o i h.iiliun- 64. Vanadium 6. 7. BOD (5 day) Soluble BOD (5 day) uoride 26,i Fltadnes 45. Cadmium 165. Zinc ailC * 13.1 (hd v) :• r Mm C ■.'.!( ‘ Foman 2 N i :: , iital . ( .* i! N 46.Calcium, as CaCOs 47. Calcium, Ca+? ICLPmaap 6r M tl/CN 10. Dissolved Oxygen 11. .Total Organic Carbon ‘ Nimaqen Nit* i । : N Nilenig 1 Ni:- .* 48. Chromium, Total 49. Chromium, Hexavalent 11167. Volatiles i:: viol Hor 1 Nalioger ededtS 50. Cobalt 12.'Total Organic Halides — 32, 011 an Grease _ 52.Ion 51.Copper pio cdeo/t cl "s 70. Disk Deliverables 13. Solids, Percent (%) ‘4. Solids, Settleable 33, Phenol Phosphorus Total 16, Solids. Total_ 35.34.36, Phosphorus, 15. Solids, Suspended OrthoasasP Pt 53.Lead 54 Magnesium TCLP . 1 TC-Menla. Sulfates_ 17. Solids, Total Dissolved 137-Surfactants 55 Manganese 56. Mercury :101 P Ptoml ,0 K : : j-H. . chlr : 18. Solids, Total Volatile 19. Otheresdl 38.UV254na 58. Nickel 57 Molybdenum 74. TCLP-Volatiles i. p BNA-,

MR NYC-WTC_000027703