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

NYC 9/11 Public Portal Document 'r*

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM tester WESTCHESTER COUNTY LABORATORIES AND RESEARCH [ovcom 2 Dana Road, Valhalla, New York 10595 (914)593-5575* NYS-ELAP No. 1^8 Time/Date Set: / F^orm A-70 (rev.lWf k/. < k7 3 37 J Sample Type (circle one): k ■ n- - "S'I 'J^otable 3. Non Potable Treated Bottle 2. Non Potable 4. Other __ ________ :________ ;. Chain of Custody? yes no Time/Date Collected:_______ 2__LjL__2______ Comments: Collected By: 7 'te (A-Q ./ ■ ' 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 I CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_______________________ Lab#:________________________ (circle tests) (circle tests) 1. Heterotrophic Plate 1j^ Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) / 2. 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. Macroscopic 1 (7./ Pesticides/PCB screen (508) .7. Methoprene (616) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI 978/8151) 8. Other: -■' 9. Herbicides (515) ' 9. . Pesticides (SMI 8/6630) -r- Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated?yes no It Carbamate Pesticides (531) .,-t 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) f - 12."Acid Extractables (625/8270) 13. Diquat (549) • * ',j5..>^Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/b : 14. Chiorination Disinfectiori Byproducts (551)'X.^^C^S Semivolatile Unknown Scan 15. Haloacetic Acids (552) - , v4^3»15’.Purgeable Halocarbons (DEF) Total Chlorine Res: . mg/L.

pH ■/I .’Ji 18. other - ' ■ , . " VI .A

tSJ - INORGANIC ANALYSIS REQUESTED - Lab#: *< C.-‘ (circle tests) 1. Color 20. Acidity 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimon^ " 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver ■ a 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp:. .“C) 24. Chloride 43. Beryllium V' 63. Thallium 6. BOD (5 day) 25. Cyanide 44.. Boron 5', 64. Vanadium " 7. Soluble BOD (5 day) 26. Fluoride 45"; Cadmium; A 65. Zinc 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-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 34. Phosphorus Total as P 53.Lead ICLE 15. Solids, Suspended 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..O^r:_________________ 38. UV254 57 Molybdenum 75.TCLP-BNA's 58. Nickel ''I"'’'.

NYC-WTC_6mO72M9" '