Chain of custody form, Westchester County Labs

NYC 9/11 Public Portal Document ... ......................................................... ■ ................................................. ).....................................................................

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

IIL I'J WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New’York 10595 uiMkshMtarGounty NYS-ELAP No. 10108 (914) 593-5575 z' Time/Date Set:________ _________________________ Form A-70 (rev. 1/96) SamgleType (circle one): 1. PotaW^ 3. Non-Potable Treated Bottle #‘s:f^ - j 2. Non-Potable 4. Other_____________________ Chain of Custody? .yes .no Time/Date Collected: ________ Comments: Collected By: "pM Agency Code: PWS #:_________ Source IO: .Type Descriptor:. Collected From; i . Bill to: Location’s/lndividuSrs Name , Name/Company : J ■'

street______ ' ' Street_2_______ City/SVZip - ' • ' .____________________ City/SVZip Identification of Source -__________ Phone#: Fax #: Collection Point,' ( CA, CH Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSES^ ORGANIC POTTLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:l 2:L:J. ’ . (circle tests) ■ ' ;; , { 1. Heterbtrophiq Plate ,. 1^ Trihalomdmanes (6245 / / 1. Purgeable Halocarbons (624/8260) Count (hernodialysis.&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) / 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 ’ . i 10 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: ’ ■ ■ . 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?: ves no 13. Diquat (549) @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) Yotal Chlorine Res( .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

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INORGANIC ANALYSES REQUESTED - Lab#: (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, 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. I. IV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel .i.r’VtfwkSPi.J'i'iA’.',. .5.

NYC-WTC_000071436