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Document / 4 pages

Chain of custody record, Westchester County Department of Labs

Machine-extracted title · confidence 95%

Record tracking the custody and transfer of samples to the Westchester County Department of Labs & Research.

NYC-WTC_000027862–000027865

Folder label: “24980”

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NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ; / AT

W lli iilestchester County WESTCHESTER COUNTY I ASORATOSICS ANO SE.ARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 2 / .

NYS-EI AP No 10108 Form A-70 (revia) . ime/Date Set:____________________________ C-o2S K 4: Gho, 71 00 , -200.7 Sample Type (circle one): Peli r t, 1002 , 5 mGuty*iek, 7 ■

1. Potable ) 3. Non-Potable Treated Bottle #‘s._ 2 Non-Potable 4. Other; Chain of Custody?yes no i Time/Date Collected:_____ I - o _ _____ i ■ - comments: ' . .............................................................. i

i Collected ________________ i______ Agency Code—--------- PWS #_____________Source ID:____ —Type Descriptor: Collected From: . .. ' Bill to: ’ * d Location‘s/Individual‘s Name P • y C .. lli.... .. .. ............ - Name/Company______ ______________________________ ■

( Street___? i 1.) 0 A' (MYr h/7 Street ________ . ; City/SZip_Oa/—UA/0y City/SVZip. Identification of Source • •_____ __________ __ __ _______ Phone#: Collection Point 0i2 ........................ - CA,CH,Bl? -Fax# Check#: Amount$ . ______________ _____________________ BACTERIOLOGICAL ANALYSES ORGANIC..POTABLE ... . ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES ‘

Lab# :=-= (circle tests) Lab #:___ _______ ___________ (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) 37 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) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) ,7. Herbicides (SM-18/6640; 8151) 6. Macroscopic - . 7.AP . Other:____________________ _ 9. Herbicides (515) 18 Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310- 40) Pesticides (525) 10. Glycols in Water Refrigerated?_____ yes____ _ no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12, Base Neutral Extractables (625/8270) Chlorinated7:___ __ 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) 16. Other Pesticides (SM-1 8/6630) 16. Pesticides (DEF) _ /i Total Cnonne Res: mq/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

PH. 8643 ,sk 14 j— 3 f‘rf 6 INORGANIC ANALYSES REQUESTED - Lab#_ 4 • 5 . ..... (circle tests) eWt 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. T urbidity 21. Alkalinity, as CaCOa .40. Antimony 60. Selenium 3 pH 22. Bromide 41. Arsenic;, 61. Siiver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium, d, So-lim 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 CaCOa 46. Calcium, as CaCOa CLP_ 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*2 tit Mot :AN 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 6if. Semi val iif : 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50, Cobalt i' j. P=a le PCE’s 13. Solids, Percent (%) ’ 4. Solids, Settleable 32. Oil and Grease 33. Phenol 51. ICopper 52, ron — 7 70. Disk Deliverables TCLP 15. Solids, Suspended 34. Phosphorus. Total as P -53, Lead n /.1ct Velal 70 1 0 s ‘ \ - tie 16. Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium

i 17. Solids, Total Dissolved t 18. Solids. Total Volatile 36. Sulfates 37. Surfactants 55. Manganese 50, Mercury 3 I i i * He i widet iA. (LP-Vuiatigr i 19. Other: ...' ; . ___ 38.UV254 57: Molybdenum /$ TCP ENA'S 58. Nickel

NYC-WTC_000027864

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NYC-WTC_000027864Source: NYC Law Department, mirrored locally

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