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Chain of custody form, Westchester County Labs

Machine-extracted title · confidence 90%

Document tracking the transfer and custody of samples received by Westchester County Department of Labs & Research.

NYC-WTC_000071736–000071743

Folder label: “26202

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Scanned page image, NYC-WTC_000071742
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NYC 9/11 Public Portal Document V' ' iri’ fill :ster )v.com

i/Date Set; ENVIRONMENTAL SERVICES.ISAMPLE SUB JSSjON FORM WESTCHESTER COUNTY LABORATORIES ( 5b RbSEAl 2 Dana Road, Valhalla, New Yo'rk 10£ (914) 593-5575 to*

. s NYS-ELAP No. 10108

Sample Type (circle one): ^JsPdtable 3. Non Potable Treated Bottle rs: ill 2. Non PotableI 4. Other Chain of Custody'S I—iip« Time/Date Colh Comments: Collected By: Agency Code: PWS #;________ liirce ID: Type Descriptor: Collected From: iGaa • Bill to: Location’s/lndividual’s Name S-'J; Name/Company Street__________________________ Street_________ City/St/Zip _ _____________________ City/St/Zip______ Identification of Source r « I Phone#:_______ Fax#; Collection Point MtPXU CA,CH, Bl? A.',Check#: Amounts__ 1

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS QRGANIC NONPOTABLE/SOLID ANALYSIS Lab#:^_________________ Lab#: . (circle tests) (circle tests) 1. Heterotrophic Plate 1 Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2.5 Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) ' 2. Coliform P/A (public supplies) 3; Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) ! 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic ,6< Pesticides (507) . 6. PCB’s (Arochlors) (608/8081) 6 roscopic Vt* Pesticides/PCB screen (508) It-- Metho'prene (616) 7 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other: 91 Herbicides (515) 9. Pesticides (SMI8/6630) ’la Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerate<;l? yes no 11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? 12. Glyphosate (547) 12. Acid Extractables (625/8270) yes no 13. biquat (549) r' ia Base Neutral Extractables (625/8270) Fruja Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) I34)gc/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (QEF) 16. Pesticides (SMI8/6630) 16. Purgeable Aromatics (DEf) pH ___________ 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other;__________________________ 18. Other;__________________________

INORGANIC ANALYSIS REQUESTED - Lab#; CO (circle tests) - 1. Color * 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 3. pH 4. Conductivity 21. Alkalinity, as CaCOs 22. Bromide 23. Bromate/Chlorate/Chlorite 40. Antimony 41. Arsenic 42. Barium 60. Selenium 61. Silver 62. Sodium KM 5. Corrosivity (temp:. ®C) 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium j 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. 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 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-violatiles 12.’Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s l^^olids. Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables '^Hplids, Settleable . 33. Phenol 52. Iron I^^olids, Suspended 34. Phosphorus Total as P 53.Lead I£kP 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

NYC-WTC_000071742

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NYC-WTC_000071742Source: NYC Law Department, mirrored locally

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