Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM sster WESTCHESTER COUNTY LABORATORIES AND RESEARCH ov.com 2 Dana Road. Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 NYS-ELAP n6,„10108 Time/Date Set; _ Form A-70 (rev'lO/01)

Sample Type (circle one): -P ^^^otable 3. Non Potable Treated Bottle #’s: ?57g. 2’^3, 2. Non Potable 4. Other____________ Chain of Custody?___ Yes___ No ^Time/Date Collected: 2• Comments': __________________ Collected By: Agency Code: PWS#: '■ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual's Name \Name/Company ■■

Street_________________ Street ______ City/St/Zip______________ City/St/Zip Identification of Source Phone#: Y- Fax#: J; Collection Point I CA,CH^i? YZ£z ? Check#: '‘■•/■Ambuht$''^/?^Y<Y ■ A*: ■

BACTERIOLOGICAL ANALYSIS Zab#:. /■A' V-.*

Lab#:_______________________ . ORGANIC potaPOT> Sle analysis <'4Sj®ANic'NQ^1^^ __ Heterotrophic Plate Count 4’j, Purgeable Haloca'rbons i(624/8260f5;. Z (hemodialysis & all others) __ Trihalomethanes (524) ' ,. __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ 'Purgeable Aromatics (624/8260), __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) _ Acrolein S Acrylonitrile (8260)' , Z Z __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) .. - , _ Organochlorine Pesticides (608/8081) ' __ Microscopic __ Microextractables (504) • A- j (608/8081) ' ■ __ Macroscopic _ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) Y? i _ API ; __ PCB as Decachlorobiphenyl (508A) _ Other Pestici^s (SM18/6630) Z __ Other;_____________________ _ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13)' . __ Pesticides (525) __ Glycols in Water , > ' Y / Refrigerated?yes no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270)- Chlorinated:?yes___ no Glyphosate (547) _Base NeutralExtractabies^ (625/8270) " __ Diquat (549) Zgc/MS Unknown Scan ' , Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) Other:. _ Other Pesticides (SMI8/6630) pH . _UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBE Only (524) __ Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#; __ Color __ A:idity Aluminum __ Potassiutf/.j i __ Turbidity __ Alkalinity .^Antimony ^Seleniiirn I' i/j, _ pH __ Bromide Arsenic AfSilver i __ Conductivity __ Bromate/Chlorate/Chlorite JSii,Barium __ Sodium __ Corrosivity (temp:. .’C) __ Chloride Beryllium .^Thallidm _ BOD (5 day) __ Cyanide _ Boron Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium _kfZinc I. _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ 12LE--4 ■ __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Metals/CN t A^Chromium, Total __ Total Organic Carbon _ Volatiles ' • __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Semi-violatiles Cobalt __ Solids, Percent (%) __ Oil and Grease _ Pesticides/PCB's Copper __ Solids, Settleable __ Phenol Ziron __ Solids, Suspended __ Phosphorus Total as P Lead ICLE __ Solids, Total __ Phosphorus, Ortho as P _TCLP-Metals __ Magnesium __ Solids, Total Dissolved __ Sulfates _ TCLP-Pesticides Manganese _ Solids, Total Volatile __ Surfactants _TCLP-Herbicides ±1 Mercury IZ Other: Z/?._________ _ UV254 _ TCLP-Volatiles . .^Motybdenum Z Nickel . , _ TCLP-BNA's

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