Chain of custody form, Westchester County Labs, Oct-Nov 2001

NYC 9/11 Public Portal Document J., '

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

SO Time/Date Set: WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 B NYS-ELAP No. I^fc Form A-70 (rev.1^^ II Sample Type (circle one): (£)’otable 3. Non Potable Treated 2. Non 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#: Collection Point CA.CH, Bl? Check#; Amounts

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_______________________ Lab#:________________________ (circle tests) (circle tests) 1. Heterotrophic Plate Trihalomethanes (524) ^1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) /'2.1 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 (625/8270) ’ 4. Fecal Coliform (all samples) , 5. Microextractables (504) 5. Organochlorine Pesticides'(608/8081 5. Microscopic ’■■jB. Pesticides (507) .6. PCB’s (Arochlors) (608/8081) 6. Macroscopic (j,'' Pesticides/PCB screen (508) 7. Methoprene (616) 7. API .'S. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI 978/8151) 8. Other;■ ' 9., Herbicides (515) 9. Pesticides (SMI8/6630) (^>esticides (525) 10. Petroleum Hydrocarbon Scan (310-13) - Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no >•' 12. Glyphosate (547) 12; Acid Extractables (625/8270) .id- 13. Diquat (549) •. . • ■ IS.^Base Neutral Extractables (625/8270) Free Chlorine Res:, 14. Chiorination Disinfection Byproducts (551) . (l4^'c/MS Semivolatile Unknown Scan Total Chlorine Res: 15. Haloacetic Acids (552) 1’ ;.’ ■•Y lS. Purgeable Halocarbons (DEF),. ■^-16. Pesticides (SMI8/6630) 3^,16. Pijrgea.bleArpmatics;(DEF) j 7. Petroleum/Hydrocarbo'n ^n^310-13) ■.u17;^esticides/PCB's (DEn^S-^^W'^- pH 118. Other:

INORGANIC ANALYSIS REQUESTED - Lab#; (circle tests) 1. Color J;" 20. Acidity 39. Aluminum •f' ' I 59. Potassium 'r s 2. Turbidity , 21. Alkalinity, as CaCOs 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 I 64. Vanadium j 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc S 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 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 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron 15. Solids, Suspended 34. Phosphorus Total as P 53.Lead TCkP. 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_000072607