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Chain of Custody Record, Westchester County Lab, Mar 2002

Machine-extracted title · confidence 95%

Chain of custody documentation for environmental samples transferred to the Westchester County Department of Labs and Research in Valhalla.

NYC-WTC_000074897–000074906

Folder label: “AE 05301

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NYC 9/11 Public Portal Document

A»ACeo. ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Westchester county laboratories and research 2 Dana Road, Valhalla, New York 10595 i i (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No 10108 Time/Date Set: FonnA-70(r8v.10/01)

Sample Type (circle one); f ^p»otable 3. Non Potable Trsated Bottle #’s: .<3. rwz--i ZNonPoteWe 4. Other_____________ . Chain of Custody? - Vias _ No ' Time/Date Collected: ■ Comments:

I Collected By: T- Agency Code: ___ PWS#: Source ID:1 .Type Descriptor. Collected From: 42^ BUI to: Location’s/lndlvidual’s Name _________ Name/Company_ •i'Str^________________________ _ _____ Street.;______ _ City/St/Zip_______^_______________________ _ Clty/St/Zip, Identificatlonof'Source _____ Phone#-. —;P^. '-j CollectlonPolnt _ I CA,CH, BI? ZZ BACTERIOLOGICAL ANALYSIS Lab#: > 7 ■. - < ORGANIC POTABLE ANALYSIS (hemodialysis & ail others) _TrihaIomethane8 (524) __ Pu^8abl8 Heiocarb6ns (624/8260) - | ii^CcHlforrn P/A (Public sidles) _ Volatile Halocarbons (524) Puigeable Aromatics (624/8260) S _ Volatile Aromatics (524) A^irt i ,-_i' Cpjtfe<tn,M^ (priv wen. raw, stp) Coliform (all samples) _ Total Trihalomethane Potential (510) _Organochtorfoe>^tlcidee (608/8081), -' _3 Microstroplc _ Microextractables (504) __ Maraoscopic _Pesticldesri’CBscreen (508) __ PCB as Decachlorobiphenyl (508A) _Herbicldes(515) _ Petroleum Hydrorarbon Scan (310-13) jm . -------------- __ Pesticides (526) ^f^ft^fiSetsd?^..___yes__no _CarbamatB Pestlcides (531) (^nated:? yes ^no _ Glyphosate (547) _Diquat(549) mg/L _ Chlorination Disinfection Byproducts (651) TBiChlorineRes: ______ mg/L < _jHaloa<»acAcide:(552) ?■ __ Other ‘. , ' , ' . _ V; I ANALYSIS __ Other Pesticides (SM18/6830) __UCMRU8t1 _MtBE Only (524) \ .. -... /..... .. mother '< .> I INORGANIC ANALYSIS REQUESTED - '' ' K.'‘ • .3 i'

I __ Color gftjrbjdlty __ Acidity Alkalinity ' _ Bromide B^uminum .^^Antirndny > J '__ Potassium j*-' mo jU_Conductivity _ Corrc»lvity (temp:..x_’C) __Bromate/Chlorate/Chlorite _Chlorlde .^fBeryllium Sodium i'-- •' yiBODl(5day) Carbonaceous BOD (5 day) Soluble BOD (5 day) IK B, Chemlcal Oxygen Demand _Cyahlde _ Fluoride _ Hardness. Total as CaCOa __ Nitrogen, Ammonia as N „Cadmlum __ Calcium, las CaCOa j _Calcium,Ca*2 ' i __Vanad \^"2inc : CLP tftli __D}8solved Oj^gen _ Nitrogen, Nitrate as N ±*Chiotnlum,T(^f ■Jll I r- Total Organic Carbon __. Total Organic Halides _ Nitrogen, Nitrite as N __ Chromium, Hexavalent _ Nitrogen, Total l^eldahl as N j^Cobalt B B7 SoHd8, Percehl (%) Oil and Grease ±:^>oppiw R' _'Soiids,Settieable __ ..Ptierfol' Jilron' K'' __ Solids, Suspended __ Phosphorus Total as P ^i Lead , Solids, Total __ Phosphorus, Ortho as P _ Magnesium Solids, Total Dissolved ■..-TCLR’^WcidiB®- __ Sulfetes _:i Manganese __ Surfactants .B^Mercury __TCLP-Herbicfdes _ Solids, Total Vdaflle , _TCLP-Voiatiies _ UV254 r:; Molybdenum _TCLP-8N«b iXNIctel

NYC-WTC_000074904

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NYC-WTC_000074904Source: NYC Law Department, mirrored locally

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

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