Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

W- ■ ' AceoL’ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH >vcom . (if I 2 Dana Road. Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 NYS-Ei>P No. 10108 Time/Date Set: 1 ■ Form A-70 (rev.TO/01) ~ 7^ ■ Sample Type (circle one): , 1. Potable 3. Non Potable Treated ' Bottle <s: 2. Non Potable 4. Other _ Chain of Custody?___ Yes No a I. Time/Date Collected:■■ ■ " \ ■ /. <,.^Comments: Collected By: V-A'-V e. Agency Code: i ’ PWS #: - » ■f 2 J Source ID: __ i_Type Descriptor: Collected From: Bill to:. Location’s/lndividual’s Name _____ : . Narne/Company _ Street__________________ _ ' Street'!___ City/St/Zip______________ _Xs City/St/Zip _ Identification of Source _ J Phone#: _ Collection Point VAX \ b , V-i-

BACTERIOLOGICAL ANALYSIS Lab#:_______________________ __ Heterotrophic Plate Count ....... FW Xab#: (

ORGANIC POTABLE AN/KySIS^ ^Trihalomethanes (524)’ (hemodialysis & all others) __ Volatile Halocarbons (524) _ Purgeable'Aromatics j;^624/8260) 'K:;<;/ ' " __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _ Volatile Aromatics -(524) r - : Y_ ,Acroieirr^'Action _fbtalTrihalomethane Potential (510) Orgariochldrir>^e^icides'(608/8081) 7'"; __ Fecal Coliform (all samples) _ Microextractables (SdSO:; 7 . / ;_i PCB’s (Arochlors)t(608/8081).;</;>> ' 7^^ __ Microscopic _ Pesticides/PCB screen (508) 7 ^_, Herbicides;(SM18/663d'8151)’'’ z .7 V; __ Macroscopic __ PCB as Decachlorobiphenyl (508A) ^Othef Pestiddes (SMl^^^^ J- ' _ API __ Other:_____________________ __ Herbicides (515) : 'ZL Petroleum Hydrocarbon Scam (310-13), _ Pesticides (525) ./ Glycols ia Water 7? Refrigerated?yes no Carbamate Pesticides (531) V;__ Add Extractables ‘(625/8270)*^^ ■i

_ Glyphosate (547) < 7 7 Iz Base Neutral Extractables W5/8276)' Chlorinated:?yes no _Diquat (549) " v<GC/MS Unknown'Scan - ^ < Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) __ Phthalates.(606MS) ‘ i .; Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ 0ther:_!__<2__<£i_J<___-__ ' _ Other Pesticides (SMI8/6630) pH ________ ___ _ UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBE Only (524) __ Radon __ Other_____________________

INORGANIC ANALYSIS REQUESTED ■ Lab#: __ Color __ Acidity Aluminum __ Potassium, i , _ Turbidity __ Alkalinity i_ Antimony - Selenium^ '•K'

_ pH __ Bromide .. Arsenic Silver ■ __ Conductivity __ Bromate/Chlorate/Chlorite Barium __ Sodium 1. __ Corrosivity (temp:. .°C) __ Chloride ***<:. >- Beryllium ' AirThallium p^ - _ BOD (5 day) __ Cyanide __ Bpron __ Vanadiurn __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium IrTZinc . i _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium. Ca*^ CLP • _Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N icrChromium. Total _ Volatiles , __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium. Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N ~ ■ Cobalt _ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease Cooper __ Solids, Settleable __ Phenol Iron TCLP __ Solids, Suspended __ Phosphorus Total as P j.£;-Lead __ Solids, Total . __ Phosphorus, Ortho as P __ Magnesium _TCLP-Metals ... . . __ Solids, Total Dissolved _TCLP-Pestiddes' .. ~' ■ __ Sulfates XrManganese _TCLP-Herbicides, __ Solids, Total Volatile __ Surfactants •-■Mercury , . _ TCLP-Volatiles “; - ? __ Other: \ _________ _ UV254 2^:: Molybdenum .■ . _ TCLP-BNA’s' d .. ■ ‘? _t--Nickel ,V,,

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