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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

111 Utertchortor County

Time/Date Set:__________ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Form A-70 (rev. 1/96)

Sample Type (circle one): 3. Non-Potable Treated Bottle Vs: 1. Potable 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. I Name/Company Street____________________ Street___________ City/St/Zip________________ City/St/Zip Identification of Source Phone#: Fax #: I CA, CH, Bl? Check#;_. Amounts. Collection Point. '

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_________________________ Lab #:__________________ _____________ (circle tests) (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 Trihalomethane Potential (510) 4. Phthalates (606/8060) 4, Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5, Microscopic Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic 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) fj,(LPesticides (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) Chionnated?: yes no 13. Diquat (549) (l,3\ 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)

pH A INORGANIC ANALYSES REQUESTED - Lab#; (circle tests) ,• 3^. Aluminum 1. Color 20. Acidity 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs I 40.^ Antimony . 60, Selenium ; / ' y 3. pH 22. Bromide ; 41.i Arsenic ■ 6T. Silver 4. Conductivity 23. Brbmate/Chlorate/Chlorite ( 42j Barium 62. Sodium 5. Corrosivity (temp: .°C) 24. Chloride \ 43; Beryllium , eij'Thallium 6. BOD (5 day) 25. Cyanide '44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 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 4,7. 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 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron TCLP 15. Solids, Suspended 34. Phosphorus. Total as P , 53. Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus. Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 5^. Manganese 73. TCLP-Herbicides 18 Solids. Total Volatile 37 Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other: . 38. I. IV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

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NYC-WTC_000071051Source: NYC Law Department, mirrored locally

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