Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document -r-• ■ Vf ; 4

ENVIRONMENTAL SERVICES SAMPLE SUBMISSlbN'FORM"^^^^^

1 f 111 -Ulettehester County

’’ime/Date Set: ’ WESTCHESTER'COUNlj^tABORXTpRlXs^l^^^^ ’ 2’'Dana Road, Valhalla, New York 10595 ‘ (914)593-5575- ’

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< ’ . NYS-ELAP No.'l O^^^ ,

.Form A-70 (rev. 1/96, - ,

Sample Type (circle one): J^otable 3. Non-Potable Treated ■

2. Non-Potable 4. Other, Chain of Custody?yes no . ■ Time/Date Collected: I n- i " ■■ _• Commenfs; Collected By: V — . • ■ •• • s- ....... .. ' Agency Code;' PWS Source ID; ' Type Descriptor. 3 Collected From: Bill to; Location’s/lndividual's Name. Name/Company. ■’7’ Street I f > _ Street_________ City/SVZip \’^-t City/SVZip^ Identification of Source. _ Phone#: _____ _Fax #;. i' I CA, CH, Bl?, Check#: Amount$. Collection Point S"

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#;______________ Z__________ ___ Lab #; ' /■ -___________ __________ ___ (circle tests) . (circle tests) 1. Heterotrophic Plate L, Trihalornethanes (524) 1. Purgeable Halocarbons (624/8260) ? Count (hemodialysis & all others) ''ZX Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 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.- Organochloririe pesticides .(608/8080) 6. ' Pesticides (507) , 6.' PCB'S (Arochlors)(608/8080)' ' . 5, Microscopic 7. Pesticides/PCB screen (508) - 7.- Herbicides (SM-i'8/6640: 8151) 6; Macroscopic -OtheLPesticidesJSM-l 8/6630)- (. J. API. 8. PCB as Decachlorobiphenyl (508A) “f- Y Other:^ 9.’' Herbicides'(515) 9. Petroleum Hydrocarbon Scan (310-13). T 16; Pesticides (525)) . 10. Glycols in Water,.' Refrigerated? ves no 11. Carbamate Pesticides (531)' 11 .■ Acid Extractables’:(625/8270) 12. Glyphosate (547) ’ .-liBase Neutral Extractables (625/8270) '(^GC/MS Unknown Scan Chionnated?;yes no 13. Diquat (549) 14. Chlofinafion Disinfection Byproducts (551) T4. Purgeable.,Hal6carbons (DEF) ■ Free Chiorine Res:. mg/L 15. HaloacetIC Acids (552) 15*. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) ' -16. Pesticides (DEF). Total Chlorine Res: mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB'S (Arochlors) (DEF)

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INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 2^Acidity 59. Potassium 1. Color 39. Aluminum 2.-‘Turbidity 21.l^lkalinify, as CaCOs ^0? Antimony 60. Selenium 3. pH 22.fBromide 41. Arsenic 61. Silver 4. Conductivity - 23|Bromate/Chlorate/Chlorite_ 42. Barium . 62. Sodium 5. Corrosivity (temp: .°C) ■, 24^Chloride ' /■43ABeryjlium •6. BOD (5 day) 25. Cyanide , iM^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/CaCOs 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^ • ;66;.Metal^CNj 10.’ Dissolved Oxygen . 29. Nitrogen; Nitrate as N , . 48.«Chrdrinium,-Total 67. Volatiles, :T ,1. Total Organic Carbon, '30.'-Nitrogen, Nitrite as'ljl, 49YChromium, Hexavalent' 68.-Serrii';Volatiles,^ • ,-12.' Total Organic Halides 311 Nitrogen, TotaLKlelciahl as N f^cpfc^it., '■ ■■ ? ^69.' Pesticide^PCB’s) ■13; Solids, Percent (%), az.on^Gfe^^ vf,;C6ppef ■ ,70/ Disk Deliveralales ,4.-Solid's; Settle'able; 33; Phenol' 52'. Iron) ■ICLPi 7“ / _^5>Solids, Suspended' . 34.^f^hbst3horus.;ToIal as P .'S^'l^ad:- • j7)1.,TCLP^Metajs> 1.6:Solids,,Total 35; Phosphorus; p'rtho as^f 'sZ lCiagnesium,i ■ 17?',Solids;.Total Dissolved 3^. Spates. (^^Sn^hes^ ■ i;|&;^oli(ls, TStai'Volatile . 373Su^tants? JtiMercufy.. I (^■Mdrybdenunij I ^iWthen^. .StA.L.- . .! .j58'.> Nickell, , ■ .

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