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Chain of Custody Record, Westchester County Lab, Feb 2002

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

NYC-WTC_000074358–000074370

Folder label: “AE 04410

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NYC 9/11 Public Portal Document

Ill ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 UJostehesterfeonty (914) 593-5575 NYS-ELAP No. 16*108

Time/Date Set:__________ Form A-70 (rev. 1/96) Sample Type (circle one): LV ■

1y Potable 3. Non-Potable Treated Bottle #’s: 1 ' 2. Non-Potable 4. Other______________ Chain of Custody? yes" no i Time/Date Collected: Comments: Collected 8y._;____ ( Agency Code: PWS Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual's Name U Name/Company I Street__________________ _ ___________ Street___________ City/St/Zip__________ ________________ Citv/St/Zio Identification of Source Phone#:_________ Fax #: Collection Point I CA, CH. Bl? Check#: Amounts’ I

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:■ Lab #:__________________________ (circle lests) (circle lests) 1. Heterotrophic Plate 1. 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 (606/8060) .! 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) ! 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) I ’ 6. Macroscopic 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) - 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) I 8. Other; _______________ _ 9. Herbicides (515) !“■ • 9.. Petroleum Hydrocarbon Scan (310-13) I. 10. Pesticides (525) 10. Glycols in Water Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) j 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated’ : yes no 13. Diquat (549) 13. GC/MS Unknown Scan

r Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 15. Haloacetic Acids (552) 16. Other Pesticides (SM-18/6630} 14. Purgeable Halocarbons (DEF) I 15. Purgeable Aromatics (DEF) 16, Pesticides (DEF) Total Chlorine Res: rng/L ‘ 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

pH-__ t INORGANIC ANALYSES REQUESTED - Lab#: . < t Ji / (circle tests) 1. Color 20. Acidity f 39.'Aluminum 59. Potassium t 2. T urbidity 21. Alkalinity, as CaCOa UO; Antimony r 60. Selenium , 61. Silver I' 3. pH 22. Bromide {41' Arsenic 4. Conductivity 23i Bromate/Chlorate/Chlorite •,.42. Barium 62. Sodium 'I t 5. Corrosivity (temp: °C) 24. Chloride f43.'Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. •Soluble BOD (5 day) 26. Fluoride 45. Cadmium /iS5.tZinc____________ I 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CLP 1 '■ 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N , 47. Calcium, Ca'^ 66. Metals/CN 1 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N f*48; Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 4'9. Chromium, Hexavalent 68. Semi-volatiles I 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N , 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent'(%) 32. Oil and Grease <■51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol <52. Iron TCLP , r ^3.. Lead 15. Solids, Suspended 34. Phosphorus. Total as P 71. TCLP-Metals J 'l6. Sciids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides . 1 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:- 38. I IV254 ' 5.7. Molybdenum 75. TCLP-BNA’s 58. Nickel , I -i

I . „________ NYC-WTC_0C)0074363

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