Chain of custody record, Westchester County Labs, Nov 2001

NYC 9/11 Public Portal Document •r*

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

HI Time/Date Set:________ WESTCHESTER COUNTY LABORATORIES ANO RESEARCH 2 Oana Road. Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Sample Type (circle one): 1. Potable 3. Non-Potable Treated Bottlers:. P Il'ts 2. Non-Potable 4. Other. Chain of Custody? yes .no Time/Date Collected:. Comments: Collected By: j b Agency Code:. PWS #:________ .Source JD:. .Type Descriptor:. Collected From: Bill to: Location’s/lndivldual’s Name. Name/Company Street_____ _________________ _ __________ :____ • Street______ __ City/St/ZiP _______________________________ City/St/Zip_____ Identifteation of Source_^___^____ __ Phone#:_ Fax #:. Collection Point "FP?-- Ill 2.7-1 G| I CA. CH. Bl? : Check#: Amounts.

BACTERiOI Lab#:. (Ctrde tests) ' ■ ' L"^Somethanes{524) 1. Epi-ge'able Halocarbons (624/8260) 1. Heterotrophic Plate Count (hemodialy8ls & all others) 2. Wolafile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) ' 3/ Volatile Aromatics (524) W 3. Acrolein & Acrylonitrile (624) 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. Organpchlorine Pesticides (608/8080) 5. Microscopic 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 Decachlorobiphehyl (508A) 8. OthenPesticides (SM-18/6630) 8. Other:_______ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 10. Pesticides (525) 10. Glycols in Water Refrigerated? ves no 11. Carbamate Ppsticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12...Base Neutral Extractables (625/8270) Chlonnated?; .yes. .no ■ 13. Diquat (549) (l3. GC/MS-Unknown Scan 14. Chlorination Disinfection Byproducts (551) l4f Purgeable Halocarbons (DEF) Free Chlonne Res;. mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: .rng^L, , .17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

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INORGANIC ANALYSES REQU (circle tests) 1. Color ■ 39. Aluminum. 59. Potassium 2. Turbidity W. Alkalinity, as CaCOa 40. Antimony ‘ 60. Selenium 3. pH ?^B|/nide 41. Arsenic 61. Silver 4. Conductivity Bfemate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: .*C) vaicafcride 43. Beryllium 63. Thallium 6. BOD (5 day) .;|^c|^nide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) &6. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOa £L£ 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*’ 66. Metals/CN '^lO. 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. Pesticidos/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14. 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-Herbicldes 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_______________ 38. IIV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel '• • -t>

NYC-WTC_000070791