Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document 5...............—’ " **556**9*90*020000" 0* ‘ ■ • 2*7* ***** ... ................................................................. ....

(C _ eae ■ ■■ UD Utestehester County ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla. New York 10595 L .

(914)593-5575 hs 2 1 isl

YS-ELAP No. 208 t (s / Ema

urh . ime/Date Set:_______ . Form A-70 (revWfef 0‘2910-K-d5/178/80,.Y60 Sample Type (circle one): *5* 253,7052,6/, 7.3— Z-Z /5, 9031, *r7 ( 1. Potable— 3. Non-Potable Treated ■ : Bottle #‘s _ “aKon-Potable 4. Other _ * Chain of Custody? yes no Time/Date Collected: 2 * 2 1 " /c / ( } - — Comments: • Collected Bv: (4re * e .. : Agency Code: _ PWS # Source ID: n Type Descriptor: Collected From: . - . b. r Bill to: r ‘ 1 Location’s/Individual's Name ......... .A_ _ _ _ _ Name/Company i

Street _LL __ ______ _ Street crysz . - City/St/Zip Identification of Source ' C______ ___ _______ _ Phone#: ,, . - Fax #: Collection Points. A") (L4 _____________ CA, CH, BI? Check#: Amounts i J i e BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES

) Lab #: ) . ...... ( ........... -... ............ ) $ Lab*_ i (circle tests) . ......... . (circle tests) • : 1. Heterotrophic Plate - ; . 1 1 Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (herhodialysis & all others) * 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 3/ Volatile Aromatics (524) • 3. : Acrolein & Acrylonitrile (624) 2. Coliform P/A (public supplies) : ■ 3. Coliform MPN (priv well, raw,stp)" 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) ■ •

4. Fecal Coliform (all samples) • —; 25. Microextractables (504) : ; . 5. Organochlorine Pesticides (608/8080) ylal 5. Microscopic . ■ : : l ‘ 6 Pesticides (507) *-.6 PCB’s (Arochlors) (608/8080) 6. Macroscopic (7/ Pesticides/PCB screen (508) । 7.' Herbicides (SM-18/6640; 8151) . 7. API , / '8. PCB as Decachlorobiphenyl (508A) .‘8. Other Pesticides (SM-18/6630) e 9.5 Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) j. Other:__________ __ _ (10. Pesticides (525) 10. Glycols in Water ■

Refrigerated? - yes : no 11. Carbamate Pesticides (531) — - ■ - . 11. Acid Extractables (625/8270) ■

12. Glyphosate (547) B r / - 12Base Neutral Extractables (625/8270) Chlorinated?: yes f 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) i : 16. Other Pesticides (SM-1 8/6630) _ . 16. Pesticides (DEF) Total Chlorine Res: mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

pH " •

r L: INORGANIC ANALYSES REQUESTED- Lab#: 66 (circle tests) ■ ■ ) n 1. Color ; : : 20. Acidity ■ • . 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 1, 4. Conductivity ■ 23 Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: °C) 24. Chloride t: ' 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 CaCOa 46. Calcium, as CaCO3 CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca"2 66. Metals/CN : eme 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles sit ■

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 13. Solids, Percent (%) ... .. 32. Oil and Grease 51. Copper 70. Disk Deliverables ' .

TS.cLP-Mets" 72. TCLP-Pesticides 18. Solcs. [otal Volatile 3/burartants 56 Mercury 73.74TCLP-Molates TCLP-Herbicides ■ MM_t it___ _........ 2000 Sunkssbatost ......... . .... -:

NYC-WTC_000027863