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Chain of custody record, Westchester County Lab, Nov 2001

Machine-extracted title · confidence 95%

Form documenting the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000071045–000071053

Folder label: “28427

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NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

HI Utesteh0steftour«y WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 I \\ •V ,/ 1

NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Time/Date Set:_________ Sample Type (circle one): 1, Potable 3. Non-Potable Treated Bottle #'s: < 2. Non-Potable 4. Other____________ Chain of Custody? yes no Time/Date Collected:. Comments: Collected Bv: /. V/i 1/Agency Code: PWS Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name. Name/Company. Street__________________ Street________ C ity/St/Zip_____________ L City/St/Zip Identification of Source Phone#: Fax #: Collection Point I CA, CH. Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ Lab #:____________________________ (circle tests) (circle tests) 1. Heterotrophic Plate l./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 wel^, raw, stp) 4.' Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6, Pesticides (507) '6. PCB’s (Arochlors) (608/8080) 6. Macroscopic <7r Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other:___________________ 9,^ Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) . ^dr-Pesticides (525) 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) Chlorinated?: yes no 13. Diquat (549) (Tj^GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine 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)

£!±_. INORGANIC ANALYSES REQUESTEDp Lab#: (circle tests) ; 1. Color 20. Acidity /^AAluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40.jAntimony “SS^Selenium 3- pH 22. Bromide 41 .lArsenic Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite . 42./Barium "52. Sodium 5 Corrosivity (temp: .°C) 24. Chloride Beryllium Thallium 6. BOD (5 day) 25. Cyanide 44. Boron Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium rgZinc _____ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca‘^ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N •{48i 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 7 S^Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease / 51. (Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52.#ron ICLP 15 Solids, Suspended 34. Phosphorus. Total as P i S^Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates /'55\ Manganese 73. TCLP-Herbicides ^1.8 Solids. TotaLVolatile 37 Surtactants / 56.1 Mercury 74. TCLP-Volatiles 19 Other- > K 38. UV254 ( 57;Molybdenum 75. TCLP-BNA’s I 58- Nickel

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