Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

• ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 1< Mo! WESTCF ESTER COUNTY : npppATomC Mn RESEARCH C i:i 2 Dana Road, Valhalla. New York 10595 914) 593-5 75 NYS-ELAP No. 10108 Time/Date Set: 1 Form ATO (rev. 1/96)

0-03ss K- 12203817,0300 n5st,*ers piergz Sample Type (circle one): 6 Fo ,, 7 - , 5 84 5 t n t r c $ 7 y Bottle #’s:_ _______ ‘___ _2 1. Potable/ 3. Non Potable Treated 2. Non Potable 4. Other ■ Chain of Custody?___ yes____ no Comments: / Time/Date Collected:__ ______________________________ Collected _ ________________________ Agency Code:....... PWS #:...... ..... Source ID: Type Descriptor: Collected From: Bill to ■ I

Location’s/Individual’s Name /f P P if Name/Company Street I 10/5* 1 s / fl c.. - ___ 2 — Street j..... .

City/St/Zip 747/ SAe 0 /GSZs City/SUZip _ _ Identification of Source_________ Phone#:___ ________ == Fax#: / P Collection Point : 415 4.5 f i CA,CH, Bl? ____ _ „.. _......Check#: „ Amounts____

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:.......... ............_________ : Lab# ________ _... :___ (circle tests) (circle tests) ' ’ J : ‘ / 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 (625/8270) 4. Fecal Coliform (all samples) : 5. Microextractables (504) 5.. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) . Macroscopic (7 Pesticides/PCB screen (508) 7. Methoprene (616)

S wether:__ _ ____ _______ _ 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) ■ 8. 9. Herbicides (EPA1978/8151) Pesticides (SM18/6630) (0 Pesticides (525) 1. >■: tailydkomadoniacm (lu s u Refrigerated?yes...... no

Chlorinated:? yes no 11. Carbamate Pesticides (531) 12. Glyphosate (547) 11. Glycols Pe 12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:................. mg/L 14. Chlorination Disinfection Byproducts (551) (42 GC/MS Semivolatile Unknown Scan 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res: .. . mg/L 16. Pesticides (SM1 8/6630) 16. Purgeable Aromatics (DEF) pH _ 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF) - 18. Other:___ 18. Other:___ :■.____ ______ 1_____ <

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) (X 11.Colorta20ung0 2. Turbidity 20. Acidity 21. Alkalinity, as CaCO3 39. Aluminum (40. Antimony 59. Potassium 60. Selenium : ) -3.DH 22. Bromide 41. Arsenic 61. Silver i 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium ‘/ 24. Chloride (43/Beryllium (63. Thallium ; 5. Corrosivity (temp:___ .. °C) 6. BOD (5 day) 25. Cyanide 44. Boron (64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) ’■ : 1* • u . i kemmnnl 27. Hardness, Total as CaCO3 i Natyrr : Amas . P 46. Calcium, as CaCOa 47. Calcium, Ca+2 CLP 66. Metals/CN 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-violatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N (50.Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil an Grease 51.Copper 70. Disk Deliverables — Solids, Settleable ( Solids, Suspended 33. Phenol 34. Phosphorus Total as P 52.1ron 53.Lead-l TCLP_ 71 TCLP-Metals . 16. Solids, Total 36,335.7. Phosphorus, Ortho as P. SulSurffaatcetsantsM 54 Magnesium 55 Manganese 72. TCLP-Pesticides 17. Solids, Total Dissolved 18. Solids, Total Volatile 38.UV254 (57 - 56. Molybdenum Mercury 103 / 11 ’-! l' : otand • T: P v it"t 719. other ATM 58.Nickel—eT TLLBNA

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