Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

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Ill UtMtehMtor County enVjron^iental services sample submission form ^WESTCHESTER COUNTY LABORATORIES AND RESEARCH ’ • 2' Dana Road, Valhalla, New York 10595. (914)593-5575 II NYS-ELAP No. 10108 Time/Date Set:______________ _ Form A-70 (rev. 1/96) Sample Type (circle one): I Potable 3. Non-Potable Treated Bottle #’s: 7^ / /. < 'L /fo

2. Non-Potable • 4. Other_____________ Chain of Custody? yes no Time/Date Collected: Comments: Collected By: Agency Code:. PWS #:_________ Source ID: Type Descriptor:. Collected From: Bill to: Location’s/lndividual’s Name__ Name/Company___________________ /' Street____________________ Street___________________________ City/SVZip________________ City/St/Zip_______________________ Identification of Source Phone#:, Fax#: Collection Point. Z(% ><2 I CA, CH, Bl? Check#:, ~ Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:’ Lab #: (circle tests) (circle lesls) 1. Heterotrophic Plate 1/ Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 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. ^cal Coliform (all 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) 7..AP! *^8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other: 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 10. Pesticides (525) 10. Glycols in Water Refrigerated?. yes - no Ml; Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 1^ Base Neutral Extractables (625/8270) Chlorinated?: • ‘ .yes^^no-j:^- ;,13. Diquat (§4§U I GC/MS Unknown Scan M4. Chlorinatid'nlJisinfection Byproducts (551) 14. Purgeable Halocarbon»(DEF) Free Chlorine .Res:, ________ mg/L,'- ; 1'15. Haloacetic.Acids (552) 15. Purgeable Aromatics (DEF) i ; - {jt6. Other Pestkide's (SM-i 8/6630) 16. Pesticides (DEF) Total Chlorine Res: Li 7: Petroleum/Hydrocarbon Scan (310-13) 17.'PCB’s (Arochlors) (DEF) -•I '■ - > — x- - ■. \ ■'

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INORGANIC ANALYSES REQU^'^D^ab''#;i. (circle fests) [39 AluminumyyVCf f S J 1. Color 59. Potassium . 2. turbidity Alkalinity, as CaCOa [40 Antimony ’ Selenium 41 Arsenic Silver 4. Conductivity 'uW/Bpmate/Ch lorate/C h lorite 42 Barium Sodium 5. Corrosivity (temp: -’C) Stride 4^ Beryllium Thallium 6. BOD (5 day) TfSf Boron 64. Vanadium *'25'^’ Fluoride / M .7. Soluble BOD (5 day) 45. Cadmium r '6^. Zinc ■_________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N... 47. Calcium, Ca*^ 66. Metals/CN / . 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 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol Iron TCLP 15. Solids. Suspended 34. Phosphorus. Total as P Lead 71. TCLP-Metals 16. Solids, ^otal 72. TCLP-Pe'sticides

r^' 35. f’hosphorus. Ortho as P Magnesium 17. Solids. Total Disso^ed 36. Sulfates Mangapese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56.1iMercury 74. TCLP-Volatiles Other; 38.UV254 57/1Molybdenurh’ 75. TCLP-BNA’s -1^ Nickel ^ .

NYC-WTC_000070874 *