Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document --- * m -y ' Pm* -** . • * 1st.**" V ’ ’ .—71109 ' •. ‘X h ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster vcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 UE (914) 593-5575 NYS-ELAP No. 10108 e/Date Set: 1 ? 176 Form A-70 (rev.1/96)

Sample Type (circle one): ---- V *1=7 / 95, ■ 7 e - Q: P5, : Bottle #s: tPotable 3. Non Potable Treated - Ct / 77 2. Non Potable 4. Other-Ae---- Chain of Custody? ‘ yes no Time/Date Collected: LA, c i ’ $ Comments: /t * 3 4 Agency Code: PWS#:__________ Source ID: Type Descriptor Collected By: 7 Collected From: fl ILLV tp Ax $ Bill to: Location’s/Individual’s Name Name/Company Street_____________________ Street___________ _ 1 City/St/Zip________ Identification of Source —_____ — Phone#:_________ Fax#: Collection Point — 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) @acroscopic (7, Pesticides/PCB screen (508) 7. Methoprene (616) 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other. -_____________ 2 9 Herbicides (515) 9. Pesticides (SMI8/6630) (10 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) Base Neutral Extractables (625/8270)

I 13. Diquat (549) Free Chlorine Res: mg/L 14. Chlorination Disinfection Byproducts (551) GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) PH__________ 17. Petroleum/HydrocarbonScan (310-13) v 17. Pesticldes/PCB’s (DEF) V

marey 18. ___________ _ s . 18. Other: ___________ 1 INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity. *•

39. Aluminum Midala 59. Potassium > i 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 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 43. Beryllium 63. Thallium 6. BOD (5 day) 7. Soluble BOD (5 day) 25. Cyanide 26. Fluoride 44. Boron 45. Cadmium 64. Vanadium 65. Zinc 4 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 413 Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables C Solids, Settleable 33. Phenol 52. Iron 15. Solids, Suspended 34. Phosphorus Total as P 53.Lead TCLP 71 .TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 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

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