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

NYC 9/11 Public Portal Document ... - .... .......... ..

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM tester WESTCHESTER COUNTY LABORATORIES AND RESEARCH nov.com 2 Dana Road, Valhalla, New York 10595 .-«-(914) 593-5575 NYS-ELAP No. 1|^ Time/Date Set: Form A-70 (rev.lUp

Sample Type (circle one): 1. Potable 3. Non Potable Treated Bottles; 2. Non Potable 4. Other Chain of Custody? yes___ no Time/Date Collected:_________________ _ A,. Comments: Collected By: j j/^• Agency Code: . PWS #:________ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name I--' ’■ CCt/lL- <O Name/Company _ Street Street_________ City/St/Zip City/St/Zip - Identification of Source Phong#:_______ Fax#: Collection Point V • I CA.CH. Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS A ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_____________ Lab#:_____________ (circle tests) (circle tests) >■".. <5 1. Heterotrophic Plate 1. Trihalomethanes (524) ,*■ 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524)f^^-,5&^ ^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 (51 Of '’4; Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) - -S;, 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. PCB's (Arochlors) (608/8081) 4 6. Macroscopic (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) ■ Pesticides (525) 10.. Petroleum Hydrocarbon Scan (310-13) Refrigerated? yes no 11. Carbamate Pesticides (531) 11; Glycols .;:i , Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (549) ; Neutral E)dractables (625/8270) Free Chlorine Res;. 14. Chlorination Disinfection Byproducts (55iy,v» fl>GC/MS Semiyolatile Unknown Scan 15. Haiqacetic Acids (552) Pufgeable Halocarbons’ (DEF) . Total Chlorine Res:

w 16? Pesticides (SM18/6630) . Puf^able ^om^^^ ' pH a: ' 17. (^um/Hydr^^;^(S(<(^J3)Wr4^^

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) £ 1. Color 20. Acidity 39. Aluminum,’ y' 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony . ' ‘ ‘ 60. Selenium , 3. pH 22. Bromide 41. Arsenic r ? -. ; • . 61; Silver 4; Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium ‘‘•4 ' . 62;'Sodium 5. Corrosivity (temp:. .®C) 24. Chloride 43. Beryllium «. 'i ' 63.Thallium 6. BOD (5 day) 25. Cyanide 44. Boron s, .. 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46.Calcium,’&s 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 34. Phosphorus Total as P 53.Lead / I£LE 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. Other:_________________ 38. UV254 57 Molybdenum 75.TCLP-BNA's 58. Nickel

Jl. NYC-WTC_000072610