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Chain of custody form, Westchester County Dept of Labs, Oct

Machine-extracted title · confidence 95%

Chain of custody record for samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000027804–000027811

Folder label: “24944

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NYC 9/11 Public Portal Document • * - Pram x weRE —

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Jrcherter county 614)5938575 -E42 NYS-ELAP No. 10108 “he/Date Set:_______ —:» 004—24125 . ) Form A-70 (rev. 1/96) Sample Type (circle one): 22 Ae 2.141 0023,47 1. Potable 3. Non-Potable Treated Bombs? 226,2025 7 ...2 7 2. Non-Potable 4. Other ______________ Chain of Custody?_____ yes no Time/Date Collected: ' h. > 0 81 43 Comments:_____________ y.- Collected By:".’ - : y // r Agency Code: PWS#:________ “Source ID:. .Type Descriptor: 3. Collected From: Bill to: Location’s/Individual’s Name. Altylelo Name/Company__ Street__________________ Street_________ City/St/Zip_______________ City/St/Zip______ Identification of Source_ Phone#:_ -Fax #: Collection Point. “2, CA, CH, Bl? ' Check#: Amounts. ■ 7t •7 BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES . J ORGANIC NONPOTABLE/SOLID ANALYSES ? p-a Lab#:______________________ Lab#:________________ ;________ — (circle tests) (circle tests) 1. Heterotrophic Plate 1 Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) 1 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) $p Count (hemodialysis & all others) 2. Coliform P/A (public supplies) -3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) is 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) ; 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 6. PCB’s (Arochlors) (608/8080) 5. Microscopic

SP; 6. Macroscopic G Pesticides (507) Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) 7. Herbicides (SM-18/6640; 8151) 8. Other Pesticides (SM-18/6630) “Other:________________ 9. Herbicides (515) (10. Pesticides (525) 1 1** 9. Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water Refrigerated? yes no 11. Carbamate Pesticides (531) j: 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: yes no 13. Diquat (549) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) ,3 16. Other Pesticides (SM-18/6630) ”. - 16. Pesticides (DEF) i 5 Total Chlorine Res: mg/L 17. Petroleum/Hydrocarbon Scan (310-18) 17. PCB’s (Arochlors) (DEF) i

pH . . if g. 1A y 7 INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1. Color 4 20. Acidity ct W 1 f yU2 39. Alumin 0

59. Potassium 2. T urbidity 21. Alkalinity, as CaCO3 40. Antimoi 60. Selenium 3. pH 22. Bromide 41. Arsenidg 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) 25. Cyanide 44. Boron 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 CaCO3 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-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB's (s Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables ' U Solids, Settleable 33. Phenol 52. Iron ISLE 15. 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 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_____________ 38. UV254 57. Molybdepum 75. TCLP-BNA’S s 58. Nickel P ‘_____ . amk. o n a—lpozas=yzL»nt NYC-WTC_000027811

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NYC-WTC_000027811Source: 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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