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Document / 4 pages

Chain of custody form, Westchester County Dept of Labs

Machine-extracted title · confidence 85%

Form tracking samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000071501–000071504

Folder label: “27288

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Scanned page image, NYC-WTC_000071504
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NYC 9/11 Public Portal Document

■■ ’ SM * • ENVIRONMENTAL SERVICES SAMRLIMbMI^SIO^ FORM '

HI •Utertsho^tour^ ' Tirne/Date Set; ' -' ■ ‘ WESTCHESTER COUNTY-LABORA^ . ' - -' 2 Dana R6ad;;yalh~ail4; NewVork 10595 7 i-r* . RESEARCH

(914)593-5575 ’ . / - •re NYS-ELAPNo;10108^ • Form A-76 (revz1/96) SamBleJ:yil^(ci>cle one): V, '■ , . - ' ppg, 1-772-1 Ktswi' VPota^--^ '•/- 3. Non-Potable'Treated,^ Bottle #'s:_^ o'Ufe ■ 2.'.Nori-Potabte. :?,<■ 4.-.Oth8r .. _ _ Chain'of Custody?' '-yes ' * no

Time/Date.Cplibcted: '■ J ■ ■ _ Comments:_______ • ' ■ - - ■ -______ :________ , 'Collected By:' P '• C CfX^^ Agency Code: ' _ . PWS #:' ' ■ ID:Type Descriptor: Source ID:, __Source Collected From: . q Bill to: ' ■ Location’s/lndividuai's Name r / C y L> &-__________ _ Name/Company. RtrPAt - - M _ Street City/St/Zip Act A _ City/St/Zip Identification of Source -______________________ J Phone#:. ' Fax »:__________ __ Collection Point'- CTQ H _ __ I CA, CH, Bl? Check#; Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE,ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES -Lab (circletests) ’■ ."7.- ' .■ - (circletests) ■' . . • 1. HeterotrophicPlat'e'. ■,< ' ■' 1. Trihalomethanes (524) . 1. Purgeable Halocarbons (624/8260) -Count (he^'odialysis &'all others)' Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Co!iiorm;P/A'(public supp(ies) ts/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) . r.r' 3.; Colifprfrf.MPN;(priy;well, ra.w. stp) 4. 'Total Trihalomethane Potential (510) • 4. Phthalates (606/8060) 4. .Fec3l.,(^lifbrhn.'(all'samples)'' ■■ ‘ •5. Micrbe,xtractables.(50'4) ” ' , 5J brganochlorine Pesticides (608/8080) .5._Microsc^ic-'' ' " ■ " .■ Pesticides (507) ' . , -/6. PCB’s (Arochlors) (608/8t)80) ■ '6; Macroscopic ; . 'Pesticides/PCB screen (508) 7. Herbicides ,(SM-18/6640; 8151)' , 7. API . ;V 8? PCB as Decachlorobiphenyl (508A) ' _8., Other Pesticides (SM-18/6630), ^8. Other:'; ■ 9Y Herbicides (515) „ ; 9^^ Petroleum' Hydrocarbon Scan‘'(310-13) @_Pesticides’(525); 10? Glycols in J^ater' lR^ngerated?''±: yes' ■■ -no 11. Carbamate Pesticides (531); 11. Acid Extractables (625/8270) ■ 12.'.Glyph6Ute(547) ' 1Z Base Neutral Extractables (625/8270) **Chlorinated?: "■ --'yes’- no ^13..Diquat (549)^' , . -. _ (^GC/MS Unknown Scan ;14' Chlorination Disinfection ^products ’(55i) 14c ^urgeable Halocarbons (DEF)" ^’/Free Chlorine Res:; —i—nng/L 15...Haloacetic Acids''(552) ‘ . i sT-Purgeable Aromatics (DEF)r ' ' 16. Other Pesticides (SM-J8/6630)' '16. Pesticides (DEF) Total Chlorine Res:""' y/- mq/L 17.' Petroleurn/Hydrj^arbon Scan (310-13) ? 17. PCB’s (Arochlors) (DEF),

■ ' INORGANIC ANALYSES REQUESTED - Lab^: (/I / )- . 'r. v (circle tests) „ . ,• , • - ‘7” / ' .1; 'Color'/' 20. Acidity ■ ^SzAluminum \§9^otassium 3 ' 2. Turbidity ' 21. Alkahnity, as CaCOa • , (40^ntimony,. 60. Seleniurri 3.'-pH . '22. Bromide •' 41. Arsenic 6,1,^Silver > ' . 4. Conductiyity. ■ " , . 23. Bromate/Chlorate/Chloritp■ , ,42. Barium. •- Qg.'Sodium • 5. 'Corrosivity (temp:____°C) ' 24. Chloride' ' (^3?5Beryllium , X^^Thallium ■ -- 6.7BOD (5 day) 7 '/ 25.‘Cyanide ■■ . ' „ 44. Boron fM^anadium'. .7. ■ S'61ub»e^bp (5day), .26.,Fluon^^ ' 45.;Cadmium ’i§M?Zinc ■ 8? Carbonaceous BOD"(5 day) ; 27. Hardness, Total as CaCOV 4^Calcium',lasl^COaj CLP 9. Cherpical^Oxygen Demand- 28.! NitrogenlAmmoniaas'N </7/Calcium,-Ca*^' 66.'Metals/CN 7. 10?-pissdlyed Oxygen^? •• . • 29^Nitr^nfNil)^e'as N? • • i&C^miumXTc^al/ ' - , 67.tyolatiles,> 11; Total Orgi^lc,Carbon 3b7Nitrpgen,'Nitrite;as N 4^Cpromiurn;B7exayaleht7 ■68.-.Semi-volatiles\'" i- ■■ J2.?tptal;brg^'i^.Halides,^ •_ 31 .-"Nitrogen, YotaCKjeldahl as N' ’(S^C^ba^'i ;69;’f^esticides/PCB;^ 13.j Solids, percent (^ : 32'i6il.an'd.Gjease'-T ^Copper: :7oXDisl< [Qeliverabres f i'4.iSolids; Settleable’}!' SS.^J’h-'e'nol / <5^1 rom ' jTCLPi ' •; , .liSiSdlids^ Suspended > y ^Rhosptibriii^fbtaPasiFjr ' 53..Leadj . i7j:--TCLP-Metals' f l67Solids7ToTal‘ ' ^..Phosphorus,-Ortho.as)P7 (^Ma'gnesium« ,-72.'jCLP-5esticides .17? S.olidl-iTbtaLDjssdlvedjl 36/^ul’fatesj ‘ tS^fClantfane’se;- . -^t?<CLP,-Heihici^es;;. .) I ,377^urfa^t'arifs5 . ^jt^Mercury; >74.-TGLR-,yolatileSj ik ■'i?.8^uV25/JJ* Q^;<ay^aenu^i '• V75;’rCLPrpN^^ . . ..I .A .

NYC-WTC_000071504

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NYC-WTC_000071504Source: NYC Law Department, mirrored locally

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