Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM’*^** ' I

( t III ' LUostehester County •* .- WESTCHESTER COUNTY LABORATORIES AND RESEARCH / 2banaRoad', Valhalla, New York 10595 '

' ■•(914)593-5575 V®!

NYS-ELAP No. 10108

I Time/Date Set: ’ ’________ Form A-70 (rev. 1/96) !■ Sample Type (circle one): T (fid . t Potable , 3. Non-Potable Treated Bottle #’s: - < > . C iz / 2. Non-Potable • ’ 4. Other Chain of Custody? .yes no Tirpe/Date Collected: < P-M U 2 b cl ■ Cortimehts: Collected Bv: C- Agency Code: PWS ________ ^Source ID:. Type Descriptor: Collected From:. Bill to: Location’s/lndividual's Name I Name/Company Street ____ Street■ city/svzip ■ 'b~ I nntb i\)^^ ><>3 "IS City/SVZip- Identification of Source_______ ;___________________ _ Phone#:_________ Fax #: Collection Point fS C i '■ C; '■ I CA, CH Bl?. Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:' V' Lab #.:__2___:_______ _ _______ (circle tests) . (circle tests) 1. Heterotrophic,Plate .1.; Trihalotriethanes (524) . 1. Purgeable Halocarbons (624/8260) Count (hemodialysis &■ all others) ,’2.). Volatile .Halocarbons,(524) 2. Purgeable Aromatics (624/8260) 2. Coliform,P/A (public supplies) ■S) Volatile Aromatics (524) .3. Acrolein & Acrylonitrile (624) - 3.- Coliform MPN (priv well, favy. stp) 4.- Total Trihalomethane Potential (510) 4. Phthalates (606/8060) . . ■ 4. Fecal Coliform (all sample's) ■ '5..’- Microextractables (504) 5. Organochtorine Pesticides (60i3/8080) •— 5. Microscopic 6.; Pesticides (507) ■ 6. PCB’s (Arochlors) (608/8080) • < , - 6.'Macroscopic' 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. Other Pesticides (SM-i 8/6630) 7<ap:, . 8. . PCB as Dec'achlorobiphenyl (508A) 8. other: I . ;9/:He)bicides(515).r‘". 9. Petroleum Hydrocarbon Scan (310-13) 10. Pesticides (525) ’ J 10.'Glycols in Water Refrigerated? ■ ^yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12'Glyphosate (547)12.,Base Neutral Extractables (625/8270) M 3. Diquat (549) . (i3.)GC/MS Unknown Scan • Chlorinated?:-- yes . no 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) , Free Chlorine Res:• - mq/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)

pH • ■ - X’- > / f

INORGANIC ANALYSES REQUESTED - Lab#:^. Z- (circle tests) 1. Color • 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity s, . 21..Alkalinity, as CaCOa .. ^0,?Antifnony ... 60. Selenium . 22. Bromide ^1. Arsenic 61. Silver - P^, 4. Conductivity 23. Bromate/Chlorate/Chlorite ■ 42.-- Barium .. . 62. Sodium' 5. Corrosivity (temp: °C) 24. Chloride (^i Beryllium (-.63.'Thallium 6. BOD (5 day) .25. Cyanide l44 Boron • ~164. Vanadium 7. Soluble BOD (5 day).. 26. Fluoride . 45.’Cadmium , ; 65. Zinc _________ 8. - darbonaceous BOD (5 day) 27. Hardness, .Total as CaCOa 46.'Calcium>as CaCOa ' ' 'I CLP ' 9. Chemical Oxygen Demand ■ 28.'Nitrogen, Ammonia as N •4'7..CalciurhVCa'*- 66.- Metals/CN , '10. Dissolved Ot^gen 29. Nitrogen, Nitrate as N/■ , 48;‘'Ch'romium, Total 67._Volatiles ■ 11? Total Organic Carbon ■ - 30. Nitrogen,'Nitrite as,N -" 49/'Chrornium, Hexavalent •- ■ 68."Semi-volatiles 12.-Total,drganic Halides; , ' ' • , 3'1..NiUogen,^Total.kjeldahl as,N -'(50)^906^^^^^ ' ’69. Pesticides/PCB’s ' 13, Solids,-Percent (%) ■ •32?djj and Grease. --•« „^.:Copper 70‘. Disk Deliverables " l'<5Solids,.Settleable, ■ 33. P'heribp . \ ICLP. ‘ iS^pljdst' Suspended' '.i 34’.%Ph6sphorus?!Total as' P - .53.LLead;- J..71. T.CLR-Metais , 1,6’Sblids.LTotai: , 35;-Pho~sphorusXGftho’^'’^ R. . .54^Magn'esium‘L ” ’72.vTCL5-Resticides i 17ASolids', Totafpissolved/ - •■36tSulfates^ . • -f^SSt-Mang'ariesd]"* ‘ 73.TCL5-Herbicides. '-1 siSplids; TbtaL-VqIatilej 37/Surtactahts' 56;:M*ercury/ 74.-TCLP-Volatiles;. /1’9?'Other:; ^-4 O '" ■ 'SS- '-'^25,4’'^ . (^^57i.Mo|ybdenurn;i ^TSSfctp-^BN^s; ' ..-.' A, ;;58.',Nickel'’ . 'a ... . * ■■. i L -

NYC-WTC_000071004