Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

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111 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM . 1^ "" WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 ,iUestehestef County (914)593-5575 NYS-ELAP No. 10108 -1 ime/Date Set:__________ Form A-70 (rev. 1/96)

Sample Type (circle one): icqiiQt . 1? Potabl^ 3. Non-Potable Treated Bottle #’s;. PHfiM,Pna5; co? 2. Non-Potable 4. Other_\___________ Chain of Custody? _2___ yes no

Time/Date Collected;. Comments: Collected Bv: V) , /' Agency Code; _______ PWS #;________ Source ID: . Type Descriptor:

Collected From: Bill to; Location's/lndividual’s Name /j/c be? Name/Company. Street__ DfWc, ______ Street_________ City/SVZip 10^^^ City/St/Zip Identification of Source_________________________ Phone#; Fax #; I CA, CH, Bl? Check#; Amount^ Collection Point.

/■ BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOUD ANALYSE; Lab#;_________________________ Lab #;_______________________ (circle tests) (Circle tests) 1. Heterotrophic Plate 1.Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) ■ Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) ( 3/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 2. Coliform P/A (public supplies) 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) Y 6. PCB’s (Arochlors) (608/8080) 5. Microscopic 6. Pesticides (507) 6. Macroscopic .■ 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) ' API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) -0. Other:_____________________ 9. Herbicides (515). 9. Petroleum Hydrocarbon Scan (310-13) 10. Pesticides (525) 10. Glycols in Water? Refrigerated?yes. no 11. Carbamate Pesticides (531) 11. Acid Extractables' (625/8270)

1/ Chionnated?; yes no 12. Glyphosate (547) 13. Diquat (549) l^v Base Neutral Extractables (625/8270) tJsjGC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res;. mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF); Total Chlorine Res: mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

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INORGANIC analyses REQUESTED - Lab#;. j,' / (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium i 2. Turbidity 21. Alkalinity, as CaCOs (^^O^^Xntimony 60. Selenium " 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp; .“C) 24. Chloride ^^Beryllium (^^^Thallium 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) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^ 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-volatiles 12. Total Organic Halides 31. Nitrogjen, Total Kjeldahl as N (^Cobalt 69. Pesticides/PCB’s •>3. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables I. Solids, Settleable 33. Phenol Iron ICLP 15. Solids, Suspended 34. Phosphorus. Total as P Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles Other; _________ 38. UV254 S^Molybdenum 75. TCLP-BNA’s 58. Nickel

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