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Chain of custody record, Westchester County Labs

Machine-extracted title · confidence 85%

Document recording the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000071265–000071272

Folder label: “27007

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NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

HL IBosttwitertourty

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) C CMRT Sample'Type (circle one): Bottle #'s^' ST4 fl. Potable^ 3. Non-Potable Treated 2? NoTi-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 Name/Company Street_______________________________________ Street__________ City/St/Zip______________ ______________________ City/St/Zip______ Identification of Source __________________ ; Phone#:. _Fax #:, TV 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 Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) -*2A Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) ' 2. Coliform P/A (public supplies) J 3j/Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) Total Trihalomethane Potential (510) 4, Phthalates (606/8060) , \ 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic z&s Pesticides (507) 6. PCB's (Arochlors) (608/8080) "■ 6. Macroscopic 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:___________________

Refrigerated? yes no a Herbicides (515) I. Pesticides (525) 11. Carbamate Pesticides (531) 12. Glyphosate (547) 9. Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water 11. Acid Extractables (625/8270) 12. Base Neutral Extractables (625/8270) . Chlorinated?: .yes no 13. Diquat (549) QxGC/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)

f A 'StT------ INORGANIC ANALYSES REQUESTEDj tab#. f '-;fs (circle tests) ' ' 1. Color Afcidity 39. Aluminum 59. Potassiufn 2. Turbidify 21. Alkalinity, as CaCOs 40. Antimony 60. Seleniur^ 3. pH bromide 41. Arsenic 61. Silver ’ 4. Conductivity 23. Btomate/Chlorate/Chlorrte 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 eSZinc___________ 8. Carbonaceous BOD (5 day) 27. Hardness. Total as CaCOs 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, 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 55. Manganese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:___________ _ 38. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

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NYC-WTC_000071272Source: NYC Law Department, mirrored locally

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