Chain of custody record, Westchester County Labs, Nov 2001

NYC 9/11 Public Portal Document ■

III ENVIRONMEKTAL SERVICES SA?4PLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 ■ - (914)593-5575 y'. NYS-ELAP No. 101''

/ '^ime/Date Set:___________ ■Y ' - ' ______________ ____________ ___________ ____ Form A-7Q (rev. 1/3',., -7~v~ U "I ' I Sample Type (circle one); i i.VoUibi,-; 3. N.);i-P<!|"b!.. Treated Bonle .'.'t Ml, 0/7 r_________________ f 4. Oriter .. Chain of Custody? yes no ■III Time/Date Collected:__ ffi »-' ________________ : i/o’pmnms Collected By:./ 3'- '■ ’ ’ Agency Code: PWS ft;__________ Source ID: Type Descriptor: I Collected From: Bill to: Location’s/lndividual's Name: jxi:.... Name/Company Street._=_«________________ 1_J -V/'c Street____________ ' City/St/Zip V H t;;;- K'- r CitvZSt/Zip ' Identification of Source ......... Phone#: Fax #;( Collection Point < • ' ; rcK'ca'^Bi?^^ Check#: Amounts,

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES: ORGANIC NONPOTABLE/SOLiD ANALYSES Lab#;..______ _______________ Lab _______ _ ____ __ _____ (circie tesis) 1. Heterotrophic Plate J-.., Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & ail others):; 2.’) Volatile Halocarbons (524) 2. Purgeabie Aromatics (624/8260) 2. Coliform P/A (public supplies) i 3. ■'Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw. s’p) '4. Total Trihalomethane Poterrtial (510) 4. Phthalates (606/8060) ' 4. Fecal Coliform (ail samples) 5. Microextractables (504) 5. Organochlorine 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)

:- •’ SL:_________ w ■ 1 ,0.Pee.ici<iee(525| 11. C..di.mt. :<■ Pt: .ti.-iticr. ;5r.1; - 9, W. Glyeoie in Wet., 1 i. Aci.i tZtmct:ihitrs (625/8270) SH 12. Glyphosate (.547) 12., Base Neutral Extractables (625/8270) Chlorinated'’: ves no •’ ' 1 h CC^IS UnKOo^r: Sc:ur ............... 14. Chlorination Disinfection Byproducts (551) "14. Purgeable Halocarbons (DEF) S free Chie,me Ree: : :: . .... ; 15. Haioacetic Acids (552) 15. Purgeabie Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res;: 17. Petroleum’Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) mil

INORGANIC ANALYSES REQUE'S^DYLab#.... .’ Z) 3 i ' '~ZZLZJZLSZ_Z___Z_____ 3 tests) .................................. ...)2g Acidity 39. Aluminum, . ; ) .7 i 4 59. Potassium ; "■ dity <>21./Ukalinity, as CaCO. f 40; Antimony ■ ; Z^ 'Lt ’ .7 60. Selenium 3 pH 22. Bromide >41. Arsenic 61. Silver ■ 4. Conductivity :- '23. Bromate/Chlorate/Chiorite ;'42 Barium _62. Sodium f )^ 24. Chloride 7g Beryllium G. BOD (5 day) 7. Soluble BOD (5 day) ras ::/. lmlness, Total as CaCOa ’ 4^: < C Slumm C .CO3 ------------------------------- 8. Carbonaceous BOD (5 day) CLP ,9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, ' 66. Metals/CN 10. Dissolved Oxygen 11. I otas Organic Carbon 12. iota! Organic Halides ss— 67. Volatiles

13. Solids^ ’ercent (%) 70. Disk Deliverables _ 14. Solids: iettleable 5- SoHds: spendec 33: B n g Iron 'S-L®®'* ■ ■ "ICLP " V/ thoasP

8 l8.D :e Sixt'S? ICt.f'BNAs Nickel

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