Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM sbet WESTCHESTER COUNTY LABORATORIES AND RESEARCH iygovcl 12 — Valhall Dana Road,94 New York 10595 593a-5,575 a ime/DateSet NYS-ELAPNo. 10108 Form A-70 (rev. 1/96)

Spietype (circle one): 53538135/8 p-999 oragsey Bottle #‘s:_____________ ____ ____ __ ■ 2.Non 1. Potable) Potable' 3. Non Potable Treated 4. Other____ /____________ __ -.... .Chain of Custody?___ yes___ no Time/Date Collected:..._LA .................... . Comments: —---== 4 Collected By: _/. ee WAA__ Agency Code:___ PWS #: Source ID: Type Descriptor: Collected From: ■ , A / . 1 . e Bill to: Location's/Individuar's Name N YC De 1 / AMC *A: 3 Name/Company__

Street___ L gGT LA. DAIvE . Street City/St/Zip ...... /X1151,7 ALFALAY City/St/Zip Identification of Source..... Phone#: _ Collection Point _ GAO//__ CA,CH,BI?_ Check#: Amounts_

BArT His I OCA ANAs YSl OECANC Pelst.t. ANALHIs SR*NNONMOIAGI 1 504.1[3 Arzi YMIS Lab#:__ _______ _ __________ (circle tests) 1. Heterotrophic Plate Count (hemodialysis & all others) Lab?'/:_ _____ ______ __ (circle tests) ... { 1. Trihalomethanes (524) / 2; Volatile- Halocarbons (524) I 1. Purgeable Halocarbons (624/8260) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) L3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) - , 3. Coliform MPN (privwell, raw, stp) . 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (ail samples) 5. Microextractables (504) - , u>i”11 ■ t ■<-4n”ion) 5. Microscopic TMacroscopic—a (7) Pesticides/PCB screen (508)_ 7.Methoprene(616)Tnn 6. Pesticides (507) . ! H . (Am Mor..) (Ni so I;

gl Gaes -9, Herbicides 515) d 9, Pesticides (SM18/6630) ii. Ptlsa l ppcldpronph: M* A* a ;■ konpuiclos (HAB//un

Refrigerated? ves no (0 Pesticides (525) u * noami i Id:o 1 a ti (b 1**

Chlorinated:?..... . yes no 11. Carbamate Pesticides (531) 12. Glyphosate (547) 11. Glycols temegye 12. Acid Extractables (625/8270) . 13. Diquat (549) 13. Base Neutral Extractables (625/8270)' ■ Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 14.GC/MS Semivolatile Unknown Scan Total Chlorine Res: 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) _ 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 AN i YSIS RE OUESTEO - ।. ! (circle tests) ■■■ —

1. Color 2. Turbidity masant 20. Acidity- 21 . Alkalinity, as CaCO3 39... Aluminum .40. Antimony 59. Potassium - — 60. Selenijm. ** 3DH 22. Bromide 23. Bromate/Chlorate/Chlorite 41. Arsenic 42, Barium 61. Silver j ,62. Sodium 4. Conductivity 5. Corrosivity (temp:_____°C) 24. Chloride (43?Beryllium >63. Thallium 25. Cyanide 44. Boron 64. Vanadium 6. BOD (5 day) 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc a 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 28. Nitrogen, Ammonia as N 46. Calcium, as CaCOa 47. Calcium, Ca+2 CLP .66.Metals /CN 9. Chemical Oxygen Demand 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total . 67. Vol a ti le .68.Semi-violatiless 11. Total Organic Carbon 12. Total Organic Halides 13. Solids, Percent (%) 30. Nitrogen, Nitrite as N 31. Nitrogen, Total Kjeldahl as N 32. Oil an Grease 49,Chromium, Hexavalent 50.Cobalt----- -51.Copper 169.Pesticides/PCB‘s 70. Disk Deliverables 4. Solids, Settleable 33. Phenol 52.Iron TCLP ids. Total lids. Total Dissoh 3536,, Phosphorus, Ortho as P__d 34 Phosphorus Total as P

Sulfates _ A 71 7 CLP-Metal 1 ! ** a <i" i 5 ‘ il I nei ** ■ lids. Total Volatile 37. Surfactants 38.UV254 i M 2 /t 5 ** vattatikro 19. Other: e 1_ 75, {3 I CW As 6. Nrka

NYC-WTC_000027782