Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM x ACCo> ester jovcom Hi WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 / i; NYStEI>P Nd. 10108 Time/Date Set: Form A;70'(revJ0/01)

S^ple Type (circle one): 12 (1, F-otable 3, Non Potable Treated Bottle #'s; 2. Non Potable 4. Other » _______ | | Chain of Custody?___ Yes / No .• • Time/Date Collected: -sA V/ Comments:_____________ -".Mt ■ • Collected By: yA il- i . Agency Code: PWS #:;_________ __ Source ID:' ////Type Descriptor: 2___ Collected From: ' Bill to: - ■- ''

Lqcation’s/lndividual’s Name______ |____________________ Name/Company -wY- Street_____________ Street City/SVZip - City/SVZip Identification of Source Phone#;

Collection Point I CA;CH. Bl?/i^^ ‘-. YCheck#: Y//Si2?^duht$.

BACTERIOLOGICAL ANALYSIS Lab#: ___ __________ ;_________ __ Heterotrophic Plate Count 'Lab#:

ORGANIC POTABLE ANALYSIS TO ■ORGANICNONPOTABLE/SOLIDANALYSIS Puif^eabie Haldcarbdns^X624^266 '• (hemodialysis & all others) __ Trihalomethanes (524) Volatile Halocarbons (524) 22/; Purgeabld^romaiics ^^24/826dr' '. ? ' __ Coliform P/A (Public supplies) ■r. 2£ ?Acroieiir& Aciyidnitrile'^^^ __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) ;' " __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) _ Organochlorine Pesticides" (608/8081) '; __ Microscopic Microextractables (504) /Y'.PCB’s (Arochlors) (608/8d81)/i v A jS^esticides/PCB screen (508) /:Herbicid^'(SM18/663b,8151):/ i __ Macroscopic ^*_}PCB as Decachlorobiphenyl (508A) . _ Other Pesticides (SMI8/6630) • . ' _ API _ Other:____________________ _ Herbicides (515) Y_ Petroleum Hydrocarbon Scati (310-13)- ■ _ Pesticides (525) _ ; Glycols in Water' ./; ,;? y .7’ ? ' / Refrigerated?yes___ no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) " ? Chlorinated:?yes no __ Glyphosate (547) , _ Base Neutral Extractables (625'/8270) _ Diquat (549) /?3C/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 - L^ab#: __ Color _ Aridity '''i^f'^minum ■ Potassium ‘--• __ Turbidity __ Alkalinity Antimony jY^lenium €<> _ pH __ Bromide s^Arsenic __ Conductivity __ Bromate/Chlorate/Chlorite .^JZ^ariurfi __ Sodiurn I __ Corrosivity (temp:. °C) __ Chloride Berylliurh ^xThallium ■ *'< / _ BOD (5 day) __ Cyanide _ Bqron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Caldufn/as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N .Calcium, Ca+2 CLE. __ Dissolved Oxygen __ Nitrogen, Nitrate as N "Y^^hromium, Total _ Metals/CN __ 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 xr<P°PP®'’ __ Solids, Settleable __ Phenol ^^Iron __ Solids, Suspended TCLP __ Phosphorus Total as P •fc^ead __ Solids, Total __ Phosphorus, Ortho as P , _TCLP-Metals __ Magnesium __ Solids, Total Dissolved _fCLP-Pesticides __ Sulfates i.Z^anganese __ ^lids. Total Volatile >,-^^ercury _TCLP-Herbicides __ Surfactants •ther: _ TCLP-Volatiles _ UV254 '/Molybdenum -^Nickel . ' _ TCLP^Bf^ (•

NYC-WTC_000072863