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Chain of custody record, Westchester County Department of Labs &

Machine-extracted title · confidence 95%

Form documenting the chain of custody for samples submitted to or received from the Westchester County laboratory.

NYC-WTC_000074972–000074977

Folder label: “AE 05700

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Scanned page image, NYC-WTC_000074975
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NYC 9/11 Public Portal Document ' -g!:' S’"'Y

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES Xfib RESEARCH >2. . 2 Dana Road, Valhalla, New Yoit 10595 (914) 231-1620 Fax (914) 231-1772 II No.-10108<;.S ._______ PFR -rgRT p-zwqu p. -2Mn . Sample Type (circle one): 2^32^ 0-27*36^0^ 3.toP0tebte7ieated wi.tfc C-e^e7 MTg-i6gQ<,u< 4. Other _________________ Chain of Custody? .__ Ye8 No liTIme/Date Collected:-------- IOQ.Sr. ■■ Comments: jrMa .r Agency Code: PWS #: Source ID: Type Descriptor: ? Collected From: Bill to: T:>ep Name/Company

'Z y citv/st/zip XGVV^ J tuKj X>r>9t Street.______ lOSASl City/St/Zip fc Identtfication of SourM, Phone#:- I ^^^lectton Point UfCO 6 i4 ! I CA,CH,Bi? Check#: _ Amount$_____

9 BACTERIOLOGICAL ANALYSIS Lab#: <• -- ORGANIC POTABLE ANALYSIS __ TJihalomethanes (524) iy^atile Halocarbons (524) ORGANIC NONPOTABLE/SOLID ANALYSIS __ Purgeable Halocarbons (824/8260) ' 1 supplies) _ Pui^eable Aromatics (624/8260) MPN (priv well, raw, stp) _^*^latlle Aromatics (524) _ Acrolein & Acrjdonitrile (8260) / (all samples). ' . __ Total Trlhalomethane Potential (510) __ Organochlorine Pesticides (608/8081) Microscopic _ MIcroextractables (504) _ PCB’s (Arochiors) (608/8081) ;■ ^_^iMadpscopic __ PestIcides/PCB screen (508) _ HerblcldeS (SMl8^30.8151) - 'A _PCBa8Decachloroblphenyi (508A) _ Other Pesticides (SMI 8/6630) ■ _Herbiddes (515) _ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) _Glycoi8lhwater Y ; Refrigerated? yes no __ Carbamate Pesticides (531) _ Add Extiactables (625/8270) Wcainwed:? ___ yes no • __ Glyphosate (547) __ Base Neutral Extractables (625/8270) ’S-'- _Diquat (549) X#*<Sfc/MS Ohknowm iScan. Res:___ _mg/L _ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Res: _i_ mg/L _ Haloacetic Adds (552) Other:_______________^ " Mbs _ Other Pestiddes (SM18/6630) __UCMRLt8t1 _MtBE Only (524) t

BO IlWALYSiS requested-Lab#: _ Addity 'J^i^a^num isium _ jWkallnity />j^timony ilum? _Bromlde ? ^iJ^enlc -'A _ Bromate/Chlorate/Chlorite jj/^rium _§odliirri c:SSSa?U._'o BOD (5 tiy) . _CWi»lde j^^rylllum __ Bpron t^hallium 'Radium I -g^Cattrohacebus BOD'-0'day) - Fltic^ ; ,|„,<!<&dmilum ■ Y,.'YY -L^fl^rtew, Total ae CaCOs _ Calcium, as CaCOs ' & LX Chemical Oxygen Demand :JL Nitrogen, Ammonia as N ___ Calcium, Ca*2 I ; ±-! plsso!ved Oxygen ■ '' \^ NlfrpgM Nitrate as N ' 4„*€!nromlum, Total (^Metals/CN / — Total Organic Carbon ..Nitr^enjNitrfteMN' ;i.Vblatil88 .:jjTbtalOr5nlc^«V ?; _ ^romlum, Hexavalent lYSemi^olatlles Nitrogen. Totai Kjeldahl as N I ^9sbiiaS,^rtt^(%T'/' :_^OHahd:<Sr6a^W<;-<^' •per __Pestlclde8/PCB's I OWifc'SetBeatte^A;? ■__Phenbl? ;?<■>' '__ ' Solids, Suspended •; __ Phosphorus Total as < ••22; Solids, Total / ■ „TCLP-Metals _ Phosphorus, Ortho as P rW ^B^lbtal Dissolved Sulfates : __TCLP-Pesticides . i_;:Surfactent8 _TCLP-Herbicld6s • „TCLP-Volatiles UV254< Y:' _YJcMABNAeY'/, a k‘i f’ •

NYC-WTC_000074975

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NYC-WTC_000074851 · Box DEP Box 62

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

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