Chain of custody record, Westchester County Dept of Labs, Jan

NYC 9/11 Public Portal Document ■7 ■—.rvw.-.

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'.ocfoT’ EN^IRONiOlENTAL SERVICES SAMPLE SUBMISSION FORM rovwm westcB^'Ster county laboratories and research 2 Dana Road, Valhalla, New York 10595 o/ ■ W 1 -* 1 ■ i*ni 1x (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set; Form A-70 (rev. 10/01)

'A- ■ f Sample Type (circle one): Potable 3. Non Potable Treated Bottle #’s:

2. Non Potable 4. Other_____________ Chain of Custody? Yes___ No /.>i— Time/Date Collected: Comments: Collected By: Agency Code: PWS #:_________ Source ID: Type Descriptor: Collected From: Bill to; Location’s/lndividual's Name /23r^ Name/Company _ Street____________________ Street__________ City/SVZip____________ City/St/Zip Identification of Source _i_ Phone#:________ Fax#: Collection Point 3/i' jP CA,CH, Bl? Check#; Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:________________ ' ORGANIC POTABLE ANALYSIS, ORGANIC NONPOTABLE/SOLID ANALYSIS ;__ Heterotrophic Plate Count . __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis, & all others) __ Volatile Halocarbons-(524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well,' raw, stp) __ Volatile Aromatics (524) ' __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) __ PCB’s (Arochlors) (608/8081) __ Macroscopic ■__ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SMI8/6630) __ Other:________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) _ Pesticides (525) __ Glycols in Water Refrigerated?yes___ no __ Carbamate Pesticides (531) , _ Acid Extractables (625/8270) Chlorinated:?yes___ no __ Glyphosate (547) _ Base Neutral Extractables (625/8270) __ Diquat (549) j/GC/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 (SM18/6630) pH ______ ______ _UCMRList1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) ___ Radon __ Other ;i

INORGANIC ANALYSIS REQUESTED - Lab#; _ Color ' _ii^lurhinum __ Acidity __ Potassium Turbidity •.__ Alkalinity - z Antimony r:_ Selenium _ pH ■ -__ Bromide / ./ /Arsenic _ Silver __ Conductivity __ -Bromate/Chlorate/Chlopte /Barium __ Sodium __ Corrosivity (temp:. ’C) __ Chloride .i/Beryllium Thallium’. _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) ' __ Fluoride __ Cadmium __ Zinc __ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ __ Dissolved Oxygen _ Metals/CN __ Nitrogen, Nitrate as N ./Chromium, Total __ Total Organic Carbon __ Volatiles __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Total Organic Halides __ Semi-violatiles __ Nitrogen, Total Kjeldahl as N ./'Cobalt __ Pesticides/PCB’s __ Solids, Percent {%) __ Oil and Grease Copper __ Solids, Settleable __ Phenol /I Iron __ Solids, Suspended __ Phosphorus Total as P ■ _Lead TCLP _TCLP-Metals ___ Solids, Total __ Phosphorus, Ortho as P . __ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates Manganese __ TCLP-Herbicides ,__ Solids, Total Volatile _ Surfactants '/-/Mercury j/ Other: ..... ............................ _ TCLP-Volatiles _ UV254 - ' Molybdenum _ TCLP-BNA’s Nickel ■L. - ••

NYC-WTC_000073213