Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

JbV ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 NYS-ELAP No.-I(n08' 'Date Set: Form A-70 (rev. 1/96) Sample Type (circle one): i. Potable/ Bottle re: K : 2 fS'. j f 3. Non-Potable Treated 2. NOri-l^table 4. Other ________ Chain of Custody? .yes no Time/Dato Collocted:_ Comments; Collected By: ■! ■ > Agency Code: PWS #:_________ Source ID:. Type Descriptor:. Collected From: ? ; i ' Bill to; Location’s/lndividual's Name, Name/Company street_______ _ ________________________________ Street__________ City/SVZip_____________ _________ _____________ __ City/St/Zip Identification of Source fc Phone#: _Fax #:. Collection Point, 33,? I CA, CH Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSER ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES #: ■ , ■

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) 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) ^Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) 10. Glycols in Water Refrigerated? ves 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) ^2»A3C/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)

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INORGANIC ANALYSES REQUESTED - Lab#; /6 (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium 3 pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp; .“C) 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc__________ 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 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, TotaJ Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s ^^olids. Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables ^^olids. Settleable 33. Phenol 52. Iron ISLE iTsolids. 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 55. 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

NYC-WTC_000071092