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Chain of custody record, Westchester County Lab, Nov 2001

Machine-extracted title · confidence 90%

Chain of custody form for samples submitted to the Westchester County Department of Labs and Research in Valhalla, NY.

NYC-WTC_000070961–000070965

Folder label: “28468

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NYC 9/11 Public Portal Document Westchoster County ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM0Y 30 WESTCHESTER COUNTY LABORÄTORIES AND RÉSÉÁRCH 2 Dana Road, Valhálla,New York 10595 (914) 593-5575, Time/Date Set: Sample Type (circle one): 1 Potable 3. Non-Potable' Treated 2. Non-Potable 4. Other. Time/Date Collected: 11/20/01 Collected By:(Lrib Agency code:NE:iNC Collected From: Location's/Individual's Name Field Plank Street City/St/Zip, Identification of Source. Collection Point FB - 11/20/u :NYS-ELAP No. 10108 :* : Form A-70 (rev. 1/96) Bottle #'s: Pil2, 942 Chain of Custody? _yes _no Comments:.. PWS #: Source ID: _Type Descriptor: BIll 1o: Name/Company Street City/St/Zip. Phone#: Fax#: CA, CH, BI? Check#: Amount$ BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES •Lab#: (circle tests) 1. Heterotrophic Plate • Count (hemodialysis & all others) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) 4. Fecal Coliform (all'samples).. 5. Microscopic 6. Macroscopic 7. AP: .8. Other: Refrigerated? yes no Chiornated?: : _yes__ no Free Chlorine Res: Totäl Chlorine Res: mg/L. _mg/L: Lab #: (circle tests) 1: Trihalomethanes (524) 2: "Volațile Halocarbons (524)" Volatile Aromatics (524) 4._ Total Trihalomethane Potential (510) 5% Microextractables (504) 6. Pèsticides.(507) Pesticides/PCB screen (508) 8 PCB as Decachlorobiphenỹ! (508A) • 9f Herbicides ($15) 10. Pesticides (525)} 1 11: Carbämatế Pesticides (531)* $12: Glyphosate (547) 13. Diquat (549): 14. Chlorinätion Disinfectión, Byproducts" (551) 15. Haloäcetic Acids (552)* 16.'Other Pesticides (SM-18/6630) $17. Pétroleum/Hydrocarbon Scẩn (310-13) 1. :Purgeable Halocarbons (624/8260) : 2. Purgeable Aromatics (624/8260). 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) 5. Organochlorine, Pesticides (608/8080) 6..PCB'S (Arochlors) (608/8080) 7. Herbicides (SM-18/6640; 8151). 8. Other,Pesticides (SM-18/6630) Petrolum Hÿdrocarbon Scán (310-13) :10. Glycois in Water 11: Acid Extractablés' (625/8270)*: 12:Base Neutral Extractables (625/8270) 13. GC/MS Unknown Scan T4 Purgeable Halocarbons. (DEF): 15. Purgeable Aromatics (ÖEF) 16. Pesticides (DEF) 17. PCB's (Arochlors) (DEF) ph INORGANIC ANALYSES REQUESTÉD Lab#: (circle tests) *1. Color 20- Acidity Turbidity 2T Alkálinity, as CaCo: pH 22;Bromide Conductivity 23. Bromate/Chlorate/Chlorite Corrosivity (temp:_ ,24* Chloride 6. BOD (5 day) 25. Cyanide 7. : Soluble BOD.(5 day) 26: Fluoride 8 Carbonaceöus. BOD. (5 day) 9. Chemical Oxygen Demand 27:Hardhess, Total as CaCOs 28. Nitrogen, Ammönia_as N: 10. Dissolved Oxygen 29: Nitrogen: Nitrate as'N •11, Totàl Organic Carbon 30! Nitrogen: Nitrite as Nº 112: Total Orgänic Hälides 31. Nitrogen; Total Kjeldahl as N, ¡13. Solids, Percent (%), 32 Oil,and Grèase 14. Solids Settleable" 33. Phênol, {15.;Solids Suspended, •34! Phosphorus: Totalas:P: 16! Solids, Total: ¡17)Solids Total Dissolved 35:PhosphorussOriho,as.P: 36, Sulfates; $18, Solids! Total,Volätile; 37, Surlactants) 19%Otherz_ з8½LỈV254 39. Aluminum 40. Antimony 41. Arsenic * 42. Barium 43. Beiyllium 44. Boron • 45: Cadmium 46: Calcium, as CaCOj 47. Calcium, Cấ?- •-. *48: Chrömium Total: 49) Chromium, Hexavalent! 51 Copper: 52! tron: 53:Lead) 54 Magnesium, 55: Manganese: :56‹Mercurý/ 57.-Molybdenümi 58. Nickel) 59. Potassium 60. Sëlenium 61. Silver 62. Sodium 63. Thallium •64. Vanädium 65. Zinc CLP 66. Metäls/CN. i67. Volatiles 68.Semi-volatiles. 69 Pesticides/PCB's: 70. Disk Deliverables FTCLPA 71-TCLP.-Metals 72,TCLP-Pesticides 73 TCLP Hèrbicides, 74. TCLP-Volátiles) 75: TCLP-BNA'S! NYC-WTC_000070962

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