Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION I^ORM DSter WESTCHESTER COUNTY LABORATORIES AND RESEARCH ovcom 2 Dana Road, Valhalla. New York 10595 (914)231-1620 Fax (914) 231-1772 .7 n.

Time/Date Set: :-fev!r;Forin A^70 (rev. 10/01) Sample Type (circle one): 1. Potable" 3. Non Potable Treated Bottle #’s: W .. - • 2. Non Potable 4. Other____________ Chain of Custody? Yes No •V' Time/Date Collected: Comments: Collected By: Agency Code: PWS #:________ Source lD:' '■ "-Typs Descriptor^2L_ Collected From: Bill 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, BI?^ Check#: 'BSi^i^lS^buntJilgS^ ■

BACTERIOLOGICAL ANALYSIS Lab#: I Lab#;_______________________ ... tr i ORGANIC POTABLE AN __ Heterotrophic Plate Count (hemodialysis & all others) :__Trihalomethanes (524) __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) " L2' Purgeable Ardmatics ' (624/8260) ' __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) ■Acroleim& Acrylonitrile ?(826d)' viM __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) Organochlorine Pesticides (608^8081) t" ;;. __ Microscopic __ Microextractables (504) __ Macroscopic __ Pesticides/PCB screen (508) _ API __ PCB as Decachlorobiphenyl (508A) other Pesticides (SMI8/6630) . __ Other:_____________________ __ Herbicides (515) _ . Petroleum Hydrocarbon Scan (31(5-13) __ Pesticides (525) _L Glycols in Water . y?/ Refrigerated?yes___ no __ Carbamate Pesticides (531) L_ Acid Extractables (625/8270) -^ ; l^^^^^^ Chlorinated;?yes no __ Glyphosate (547) __ Base Neutral Extractables ,(625/8270). _ Diquat (549) _Y"GC/MS Unknown Scari, - Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) _■ Other: ' ' - O _Other Pesticides (SMI8/6630) pH ------------------- _UCMRList1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED ■ Lab#: M- ■■ __ Color __ Acidity _ Aluminum __ Potassium ' . , __ Turbidity __ Alkalinity. __ Antimony __ Seleniurn _ pH "__ Bromide _ Arsenic _ Silver __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium __ Sodiurn > Y "■ __ Corrosivity (temp:. .’C) __ Chloride __ Beryllium __ Thalliurn'n'4*:'$'Y _ BOD (5 day) __ Cyanide __ Boron __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as.N __ Calcium, Ca*^ CLE i Z __ Dissolved Oxygen __ Nitrogen, Nitrate as N _ Metals/CN ' __ 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 __ Iron __ Solids, Suspended __ Phosphorus Total as P __ Lead ICkE _ Solids, Total _TCLP-Metals __ Phosphorus, Ortho as P __ Magnesium __ Solids, Total Dissolved __ TCLP-Pesticides • __ Sulfates __ Manganese _TCLP-Herbicides __ ^olids. Total Volatile __ Surfactants __ Mercury _ TCLP-Volatiles ' Other:______ ___________ _ UV254 __ Molybdenum C^ TCLP-BNAIs ■ __ Nickel '.V Y ..

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