Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

X* ACCol-1. ■ -■ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM sster WESTCHESTER COUNTY LABORATORIES AND RESEARCH ovcom o A 2 Dana Road. Valhalla. New York 10595 O: .SL (914)231-1620 Fax (914) 231-1772 NYS-ELAP'NoJ 10108 Time/Date Set; Form A-70 (rev'10/01)

Sample Type (circle one): T.^otable 3. Non Potable Treated Bottle #’s: 2. Non Potable 4. Other____________ Chain of Custody? Yes No / / J Time/Date Collected: Comments: Collected By; Agency Code: PWS #:________ Source ID: '; Type Descriptor: Collected From: BUI to: Location’s/lndividual’s Name__ ; Name/Company Street____________________ Street_________ City/St/Zip_________________ City/St/Zip______ Identification of Source Phone#: Collection Point I CA.CH. Bl? : CheckW:

BACTERIOLOGICAL ANALYSIS Lab#:_______________ __ Heterotrophic Plate Count Lab#: mwf ORGANIC POTABLE ANALYSIS ( 2_Trihalomethanes (524) ; rO^^IClONf^BI^C^DT^^ : __ , Purgeable Haloc^rbons^(624/826p)Y|/4^ (hemodialysis & all others) __ Volatile Halocarbons (524) _. Pu'rgeable AforTrtatic»';3(6^4/8260)/j/;S'1^ Z’ __ Coliform P/A (Public supplies) __ Coliform MPN (priv well. raw. stp) __ Volatile Aromatics (524) __ Total Trihalomethane Potential (510) _ OrgahochlorirfePesticidesj (608/8081). __ Fecal Coliform (all samples) __ Microextractables (504) _ ^’CBi'(AF^gfe)S(6dl/8b8i)WM^?Z Z __ Microscopic __ Macroscopic __ Pesticides/PCB screen (508) - Herbicide (SM18/6630;8151)^/^fe Y:: ? -: _ API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticid^/{SMI 8/6630) . __ Other:_____________________ __ Herbicides (515) __ Petroleum;Hydrocarbon Scan ;i(31 p-l 3);^.' __ Pesticides (525) __ Glycols in vi/atefV' Refrigerated?yes no __ Carbamate Pesticides (531) _ ■ Acid ^ractables;(625/8270);^</^;//ei^..: __ Glyphosate (547) __ Base Neutral Extractables/.(625/8276)>,<Z Chlorinated:?yes no __ Diquat (549) ^>r^C/MS Unknbwh'Scari "X" rXAj* « Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) i /X; - Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ Other:____X_:_X_ZX-;LjZ_LR^^ __ Other Pesticides (SMI8/6630) pH ------------------- _UCMRList 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon __ Other.

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Aridity Y Aluminum __ P’otassium ' - , __ Turbidity __ Alkalinity .-'Antimony _i.-Selenium _ pH __ Bromide Arsenic -^Silver ; - - __ Conductivity __ Bromate/Chlorate/Chlorite Barium _ ^ Sodium . - Ym ''x . __ Corrosivity (temp: “C) __ Chloride ' Beryllium _z:Thailium X.X< _ BOD (5 day) __ Cyanide __ Boron ' __ Vanadium^/. __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium X'Zincf • __ Soluble BOD (5 day) __ Hardness. Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen. Ammonia as N __ Calcium. Ca*^ __ Dissolved Oxygen _Metals/CN . ■ __ Nitrogen. Nitrate as N ^Chromium. Total __ Volatiles' __ Total Organic Carbon __ Nitrogen. Nitrite as N __ Chromium. Hexavalent __ Seml-violatiles " __ Total Organic Halides __ Nitrogen. Total Kjeldahl as N ■'"Cobalt __ Pesticides/PCB's __ Solids.'Percent (%) __ Oil and Grease _Copper __ Solids. Settleable ■__ Phenol __ Iron __ Solids. Suspended __ Phosphorus Total as P __ Lead I£LE _TCLP-Metals __ Solids. Total __ Phosphorus. Ortho as P __ Magnesium _TCLP-Pesticides __ Solids. Total Dissolved __ Sulfates Manganese _TCLP-Herbicides __ Solids. Total Volatile __ Surfactants Mercury _ TCLP-Volatiles,. -X"Other: ___________ _ UV254 Molybdenum _TCLP-BNA:s / Y- _ Nickel

NYC-WT^000^8^