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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_000027723–000027730

Folder label: “24872

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NYC 9/11 Public Portal Document S) -= •*......... *.* -***~*i ""**"",*"*

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH com 2 Dana Road, Valhalla, New York 10595 (914) 593-5575

@ne/DateSeti____________ NYS-ELAP No. 10108 Form A-70 (rev. 1/96)

Sample Type (circle one): ((g4,086-,9758 1. Potable 3. Non Potable Treated Bottle #s: 267 388 Z /214 2. Non Potable 4. Other . t______________________ Chain of Custody?yes no Time/Date Collected: //// 05 7 Comments: Collected By: B.Getuk— Agency Code: z 0/FP _ Source ID: .Type Descriptor: Collected From!- 39 * _ Bill to: Location’s/individual’s Name /n Name/Company Street______________________ Street_______ City/St/Zip___________________ City/St/Zip Identification of Source Phone#: Fax#: Collection Point__ # 46760 20880 CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:__________________ — Lab#:______________________ (circle tests) (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 02 Pesticides/PCB screen (508) 7. Methoprene (616) WAPI 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other:__________ _ ______ 9. Herbicides (515) 9. Pesticides (SM18/6630) (0) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 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 Total Chlorine Res: mg/L 15. Haloacetic Acids (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)

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity 20. Acidity 18. Other

21. Alkalinity, as CaCOs aes 39. Aluminum 40. Antimony ' 18.Other_ —

59. Potassium 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver > 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: °C) 24. Chloride 25. Cyanide 43. Beryllium 44. Boron 63. Thallium 64. Vanadium 6. BOD (5 day) 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 50.Cobalt 69.Pestlcides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables ( Solids, Settleable 33. Phenol 52. Iron TCLP "5. 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 56. Mercury 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 74. TCLP-Volatiles 19. Other:________________ 38. UV254 57 Molyodenum 75.TCLP-BNA’S 58. Nickel

bicat 1.. NYC-WTC_000027727

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NYC-WTC_000027727Source: NYC Law Department, mirrored locally

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Record documenting sample transfer and custody for environmental testing at the Westchester County Department of Labs & Research.

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