Chain of custody form, Westchester County Lab, Sep 2001

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ill ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 C/DateSet Form A-70 (rev. 1/96) Sample Type (circle one): 0414, 8612,26*1,2i0, 3 1Potable 3. Non-Potable Treated Bottle «s0O 18571, 26 s S 7 it 7 190 3,778/ 2. Non-Potable 4. Other _________ __ _________ Chain of Custody? yes .no Time/Date Collected: 9/2 2/200/ 1 AH------- - Comments: Collected By:M-YAcouB Agency Code:_ 2______ PWS #:_________ Source ID: Type Descriptor:. Collected From: ' Bill to: Location’s/Individuars Name. Hlvtewosetotk Name/Company Street_______ ____ _____________ _ ___________________ — Street__________ ________________ — Ciy/SUZip Identification of Source. Phone*: Fax Collection Point . 6,3 ■ ■ S ’ * * " . CA.CH. Bl?. Check#:, Amounts.

BACTERIOLOGICAL ANALYSES : I ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: (circle tests) . 2 * _ • L : .: Lab*: : 22226—— / . (circle tests) .. • X = 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) 6. Macroscopic ■ . / (7. Pesticides/PCB screen (508) . 7. Herbicides (SM-18/6640; 8151) ZAP 8. PCB as Decachforobiphenyl (508A) ; 9. Herbicides (515) . 8. Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) __________ . Pesticides (525) 10. Carbamate » 11. Pesticides (531) 10. Glycols in Water Refrigerated? yes no 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: ■yes no 13. Diquat (549) 13. GC/MS Whknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) FreeChionne Res:. 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) • 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: mg/L i 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) P.

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-------------tA INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity —— pll 39. Aluminum — 59. Potassium JJ 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony I 60. Selenium 3. pH 22. Bromide 41. Arsenic 1 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium I 62. Sodium 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium ' 63. Thallium,. 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc__________ ee- 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCO3 CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*2 66. Metals/CN A 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-volatiles 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 (Solids, Settleable 33. Phenol 8. Solids, Suspended 52. Iron ISLE 34. Phosphorus. Total as P 53. Lead 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 z alszd: AR *1, .2.3 . . ■ PsthynAs * NYC-WTC_000026448