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Chain of Custody Record, Westchester County Lab, Feb 2002

Machine-extracted title · confidence 100%

Documentation tracking the custody and transfer of environmental samples to the Westchester County Department of Labs and Research.

NYC-WTC_000074314–000074318

Folder label: “AE 04381

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NYC 9/11 Public Portal Document

S|ii5i "i ENVIRONMENTAL SERVICES a 2 Dana Road, Valhalla, New York 10596 (914)231-1820 Fax (914) 231-1772 - r,; _ NYS-ELAPNo.tlQ1Q8.;l > Tirne/Date Set: ______ , / • -FQirri A-rotf^JO/QI) T S^iaiyp^rdeone,: 1 Y. I.Potablep*^ 3. Non Potable Treated Bottle #'s: ItfiS2 ill j_________

I 2. Non Potable ' 4. Other ____ _______ Chain of Custody?____________________ Yes^^No TlhleflJate Collectsd: g______Comments:______________ ? ’ , ' ' " .

( Coltecteti By: .AgencyCode: PWS #:Source ID: __Y_Type, Descriptor. __ I' ■/ I Locatlon’s/lndividual’s Name yKWiC , R" ' - " VNarhe/Ct^lSa-Bl I .Street Z I 31- V iiPhohejii: 1 II' ■/■Idetrtlflradon of'Source Collection Point CA.CH.-BI? ' ====3^======^^ S' Lab#:i BACTERIOLOGICAL ANALYSIS Lab#:____________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS

f Heterotrophic Plate Count .(hemodialysis & allothers) Coliform P/A (Public supplies) _ Co!iform MPN (priv well, raw, stp) ‘'_Tj^alomethanes (524) _i*^atiie Halocarbons (524) ij*Volatile Aromatics (524) V . _ Purgeable Halocarbons (624/8280) ■yi;j^r8e^ble^Arornas";{824(^ . _ Acrolaln & Acr3/lonitrlle Fecal Collform(a|l samples) __ Total Trihalomethane Potential (510) _ Mlcroextractables (504) _ PCB's (Arochlors) (608/8081) ’ * _Microscopic __ PestIcides/PCB screen (508) i^Wacroscoplc __ PCB as Decachlorobiphenyl (508A)

I ■^W ' _ Herbicides (515) _ other: __________ _ Pesticides (525) I Refrigerated?__ _yes no Chlorinated:? i__ _yes __ no Free Chlorine Res: mg/L _ Carbamate Pestiddes (531) _ Glyphosate (547) _Diquat (549) _ Add Extractables (625/8270) ; X. Bgs© Neutral Extractables (625/8270) .^iCGC/MS Unknown Scan -- 5' I I Total Chlorine Res: _____ mg/L _ Chlorination Disinfection Byproducts (551) _ Haloacetic Acids (552) :PWh«^-0<^ __ ;.Othef:? S SI 'pHa3X-_____ / . _Other Pesticides (SM18/6630) _UCMRList1 /RADIOCHEMICAL ANALYSIS _MtBE Only (524) ' — ' 1 -

_^Radon ./IV I. J- Other

Irf- INORGANIC analysis REQUESTED * Lab#: :2-^rSdIty Potassium ' ' - _ Acidity iminum A - Alkalinity IhlPny /^;pH.i;<;;i/ __ Bromide '“Jc .... Conductivity ; /Y Corrosivity (temp: °C) _ Bromate/Chlorate/Chlorlte _ Chloride im ,,Jlium __^adtum a ?■ BOD (5 day) 1 iY Carbonaceous BOD (5 day) __ Cyanide " _ Fluoride ■_L.BQp3n" ■ _^i^dmlum ; ' .f /M SolubleBOb (5day) __ Hardness, Tq^as CaCOa ^Caldurt^ as CaCOa _ Chemical Oxygen Demand _ Nitrogen, A^nia ad N _Cdclum, Ca*2 < Yi Dissolved O)^en __ Nitrogen, NItrate as N J^^eCnroniiurfi,.Ttota! . _ Total Organic Carbon Total Organic Halides UL. Solids, Percent (%) __ Nitrogen, Nitrite as N _ Nitrogen, Total Kjeldahl as N ^ 011 and Grease ^ Chromium, Hexavalent _Semi-vlolat!les;. ■Llipestk^d^Cffs^ a _Solids, Settleable __ Phenol ' ■ ^frcLP-Metals ; , g Solids, Suspended Phosphorus Total as P _ Solids, Total 2_ Phosphorus, Ortho as P _^agnesium u_' solids, Total Dissolved £_ SuMates Je^anganese

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Form documenting the custody chain for environmental samples submitted to the Westchester County Department of Labs.

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