Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

* r, environmental SERViCES SAMPLE SUBMISSION FORM

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fime/Date Set: WESTCHESTER .COUNTY LABOR1tOR1eS>NP RESEARCH ‘' - * 2 Dana Road, Valhalla; New York 10595 • ' . / (914)593-5575 .'f - ' NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Sample Type (circle one);

i f ' y Potable 2. Non-Potable Time/Date Collected: 3. Non-Potable 7rea(ed 4. Other r ./ Bottle , Chain of Custody?;Lyes Comrhents: no

Collected By:_ .Agency Code; PWS #:_J^_ Source ID: Type Descriptor: st. Collected From: Bill to: ' Location's/lndividual’s Name Name/Company.

L Street __ Street________ City/St/Zip I City/St/Zip. Identification of Source Collection Point, L.Z / Phone#: I CA, CH, Bl?. _Fax #: Check#: Amounts

f. BACTERIOLOGICAL ANALYSES Lab#:_________________ - ORGANIC POTABLE ANALYSES Lab #: ________ '' * ORGANIC NONPOTABLE/SOLID ANALYSES

(circle tests) ■ '

I (circle tests) 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 Trihaldmethane Potential (510) 4.. Phthalates (606/8060) ■ 4. Fecel Coliform (all samples) 5,. Microextfactables (50.4)' • 5. Organochlorine Pesticides (608/8080)’® 5. Microscopic .6./P.esti6ide8,(507)... 6. PCB's (Arochlors) (608/8080) ' 6. Macroscopic 7,' 'Peslici'des/f’CB screen (508)" 7. Herbicides (SM-i 8/6640; 8151) A API. - ■ , • :8; .PCSas DecachlorbbiphenyllsbSA)? . ■8.- Other PesticldM'(SM-18/6630) . .-rj & Y J. Other:____________________ ' -9^ Herbicides {5<5)’ " 0.? Petjoieiim Hydrocarbon Scan’(310:13H. , ’’10. Pesticides-(525)- „ lO/Glycols in Water / ' ■ . -t;? Refrigerated? .yes no ■ ' 1 i? Carbamate Pesticides“(531)! - y . Acid Extractable8;(625/8276j'. .12. Gly|ihosate (547)’ " ' J^Base Neutral Extractables (625/8270) Chlorinated?: yes ‘ no 13', Diquat ■(549) > Q^GC/MS .UnknownScan ; 14.’ Chlorination Disinfection'Byprod(S:ts’;(55j)? 14- ^u>geabl.e Haldcarb'ohs (DEF).

[ Free Chlorine Res: ' ■ mo/L 15. Haloacetic Acids (552)^ 15. Purgeable’Arornatics (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) ■ Z -.

v- pH.

INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color .2. Turbidity 20. Acidity 21. Alkalinity, as CaCOa 39.^^"Aluminum . ^O.'Ant^'ony i ; 59. Potassium -’"60. Selenium f . '3.”pH 22. Bromide ‘ , 41. Arsenic ■ I ' 4. Conductivity 23. Bromate/Chlorate/Chlorite 4g.(Barmm .5. Corrosivity (temp: °C) 24. Chloride f43.'’Be®lium ^^^iThallium | 6. BOD (5 day) 25. Cyanide ‘ ’44.’ Bor|n ^f'''&4iiiVdnarfiLi’m I 7. Soluble BOD (5 day) 26. Fluoride ' .45. Ca^ium •65: Zinc 5 8.. Carbonaceous BOD (5 day) 27. Hardness, Total.as CaCOa. ^.g^Calcjurn, as CaCOa 9. Chemical Oxygen Demand • 28.-Nitro'gen, Ammonia as N ’ ■ *^W5Cat(aBiBarCa*Ar^, / , 66.-Metals/CN 1 o; Dissolved^Oxygen ' 29.'Nitrogen,- Nitrate as N - 48^.iChrdmium,LTotaL <’ ‘67.>’^olati!e.ss 1 r.Total Organic Carbon 30. Nitrogen, Nitrite as N j 49.’ Chromium/Hexavalent ' 68? Semi-volatiles'- ' j12? To(al Organic Halides. 31. Nitrogen, Jotal Kjeldahl aVNJ<^^(^^ ' ' ’6f',^esticides/PCB’s'’ . <3.-Sol?^', Percent/%)’■ .. 32. Oifand 676850' Sj.V^Ipper’’ 170.^ DiskPelive rabies. ±—Xi— •33: Phenol'■■ ■' fWlronf . ------ - --------- .. S oil'd s; Settleable' 715?,SoJ1ds> ^spen’ded ' 34;Bhosf^us>aotal ’as.5^-^ S^ea'd/’ j7l7TeLP'-MetalSx f.

•c Solids? Total J * 35: Phosphorus) Ofthd/as.P ’ ‘.54?-Maghesium'' ^2\TG11R/F^sticides7 i 7? Solids’; Tot^'Diss’olved' 36. Sulfates.-* , ^^^>‘»San*ganes^f .73?JGLP'-Herbicides’i 37ZSurfa^nts.i ■ ■ ^Mercujy.f i74;jCLP-Volatile^ { 38’.-liV25^ L - <57?. Molybdenum/. r75; W-bNa’s; L . ...... .. , 58'/Nickel’’ I . .Sr. . . ...... fe,.. NYC-WTC_000070922 T