Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ter WESTCHESTER COUNTY LABORATORIES AND RESEARCH :com 2 Dana Road, Valhalla, New York 10595 ’T - (914) 231-1620 Fax (914) 231-1772 V/' ix NYS-ELAP No. 10108 Time/Date Set: ■ Fonp A-70 (rev.lO/OI)

Sample Type (circle one): 1. Potable 3. Non Potable Treated Bottle #’s: 2. Non Potable 4. Other Chain of Custody? Yes No-A, ,• , . ,•\ .. Time/Date Collected: I ! ». . ■ ' x_____ Comments: Collected By: Agency Code: PWS #:______ _A___ Source ID: type'Descriptor: - Collected From: Bill to: Y;-; ' -Y Location’s/lndividual’s Name r> ' A.-;-;" /

Street________________ Street " City/St/Zip _ __________ \ City/St/Zip Phone#?£lgxW^^ Identification of Source Collection Point I CA.CH.^Bi?

BACTERIOLOGICAL ANALYSIS Lab#:- g" I I Lab#:_______________________ ORGANIC POTABLE XnAIYSIS I z? ; __ Heterotrophic Plate Count _TrihalomethanesiX524) ' (hemodialysis & all others) __ Volatile Halocarbons (524) ' ’ __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _ Volatile Aromatics (524) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) . < _ Or^gatidchlorine'Pesticides (608/8081 ) • ’ > _ PC^s(Arochlors).(608/8081)B-^:i^-< ' __ Microscopic __ Microextractables (504) . ..‘ Vrk __ Macroscopic __ Pesticides/PCB screen (508) <' 8 ■ _Y< Herbidides;(Skil'8/66S)-8151)'^.y,$^^ _ API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticide :;^M18/^3W);^1 _ Other:____________________ _ Herbicides (515) X12 Petroleum Hydrocarbon Scan ,(310-13) ;’. _ Pesticides (525) Refrigerated?yes no __ Carbamate Pesticides (531) . _ . Acid Extfactables . (625/8270) s- Chlorinated:?yes no _ Glyphosate (547) ^se Nei^al .Extractables; (625/8270) , >^^^ _ Diquat (549) _v*GC/MS Uhknowri'Scan ' Y/,- Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) ’ 'Y - YY C Total Chlorine Res: .mg/L __ Haloacetic Acids (552) _ Other: - ' -Y _ Other Pesticides (SMI8/6630) •'V- r’’ * pH ------------------- "777..J- __ UCMR List 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#; __ Color __ Acidity li. Aluminum __ Potassiurjiy ., , __ Turbidity __ Alkalinity __; Antimony — pH __ Bromide __ Arsenic __ Conductivity __ Bromate/Chlorate/Chlorite Barium __ Sodium . - __ Corrosivity (temp:. .’C) __ Chloride .iX Beryllium ;' 4<xrhallium _ BOD (5 day) __ Cyanide __ Boron Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium Zinc - / _ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOa "CLP i __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ __ Dissolved Oxygen __ Nitrogen, Nitrate as N _Metals/CN Chromium, Total __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Volatiles __ 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 _L Iron __ Solids, Suspended __ Phosphorus Total as P Lead ICJLE __ Solids, Total __ Phosphorus, Ortho as P _TCLP-Metals __ Magnesium __ Solids, Total Dissolved __ Sulfates _TCLP-Pesticides Manganese __ Solids, Total Volatile _TCLP-Herbicides ’ . __ Surfactants ___ Mercury ■ Other: ____________ _TCLP-Volatiles/;--> .- _ UV254 . _ Molybdenum _TCLP-BN^;^i. . - p; 7 _ Nickel

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