Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document RP -- *~2M4ys* .4s**ypmtp.•,* • 70**

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM eStCDester geeengovcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH fansne? 2 Dana Road, Valhalla, New York 10595 1E (914) 593-5575 NYS-ELAP No. 10108 e/Date Set: Q 'Z- Z Form A-70 (rev.1/96) pie Type (circle one): , < 55% ?k*zy, 097% 2y otable 3. Non Potable Treated Bottle w‘97sS 9788 573 $/67/,792 2. Non Potable 4. Other________________ _ Chain of Custody? yes no Time/DateCollected:" /-/d:01________ X 4 4 Comments: Collected By: o/A/ Agency Code: PWS#:_______ Source ID: .Type Descriptor: Collected From: Bill to: Location’s/Individual’s Name Name/Company _ Street__________________________ Street________ City/SVZip_______________________ City/St/Zip Identification of Source DePt Phone#:______ Fax#: Collection Point Jwe3/07J3 20804 CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________________ Lab#:______________________ (circle tests) (circle tests) 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. CoBform 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 Pesticides (507) 6. PCB's (Arochlors) (608/8081) ^Macroscopic API Pesticides/PCB screen (506) d 7. Methoprene (618) 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other__________________ 9. Herbicides (515) 9. Pesticides (SM18/6630) 10 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractabies (625/8270) 13. Diquat (549) 13, Base Neutral Extractabies (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) ✓ 14.GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L S r 15. Haloacetic Acids (552) —ts. Purgeable Halocarbons (DEF) _ 316. Pesticides (SM18/6630) - 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 7Pesticides/PCB‘s (DEF) 4 . 118. Other. __ __________________________ ============================================ INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity OMY76 39. Aluminum * • 59. Potassium ; d. - 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver i 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 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 i 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*2 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-vlolatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobalt 69.Pesticides/PCB’s 23. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables U. Solids, Settleable 33. Phenol 52. Iron TCLP 15. Solids, Suspended 34. Phosphorus Total as P 53.Lead 54 Magnesium 71 .TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73.TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 38. UV254 57 Molybdenum 74. TCLP-Volatiles 19. Other________________ 75.TCLP-BNAs 58. Nickel

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