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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 ATr

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM tester lbv.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 1 2 Dana Road, Valhalla, New York 10595 (914) 593-5575

ft e/Date Set: NYS-ELAP No. 10108 Form A-70 (rev.1/96)

Sample Type (circle one): Bottle #s: t_____ ‘s 1. Potable :3. Non Potable Treated *---------- — 2. Non Potable -4. Other__________ Chain of Custody? yes no Time/Date Collected: 1 -10 1 I 080+ Comments: Collected By: eus(5 Agency Code: _ Source ID: Type Descriptor Collected From: Bill to: Location’s/Individual’s Name H * Name/Company _ Street_____________________ Street________ City/St/Zip__________________ City/St/ZIp Phone#: . Fax#: Identification of Source Collection Point 2 0 G \D 28809 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 Pesticides (507) 6. PCB’s (Arochlors) (608/8081) (•Macroscopic WAPI 6 Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) 7. Methoprene (616) 8. Herbicides (EPA1978/8151) 8. Other:__________ _ ____ __ 9. Herbicides (515) 9. Pesticides (SM18/6630) Refrigerated? yes no (10) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) 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) d4./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

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) lrawo=nrpqc"yy" — ado 17. Pesticides/PCB’s (DEF) 18. Other ___________ '

f$ — 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium i 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 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 50.Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables (. Solids, Settleable 33. Phenol 52. Iron TCLP •15. Solids, Suspended 34. Phosphorus Total as P 53.Lead 71 .TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 36. Sulfates 55 Manganese 72.TCLP-Pesticides 17. Solids, Total Dissolved 73.TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 38. UV254 57 Molybdenum 74. TCLP-Volatiles 19. Other:________________ 75.TCLP-BNAs 58. Nickel

NYC-WTC_000027729

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NYC-WTC_000027729Source: NYC Law Department, mirrored locally

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NYC-WTC_000026432 · Box DEP Box 19

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

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