Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERvicES SAMPLE SUBMISSION FORM’ Si^vcom WESTCHESTER COUNTY LABORATORIES AND RES^RCH , 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 / /yS-ELAP No. 10108 Time/Date Set;

Sample Type (circle one): <1.^ Potable^ 3. Non Potable Treated Bottle #’s: _ C/57g, h7^ 2. Non Potable 4. Other__ Chain of Custody?Yes No Time/Date Collepte^; OCIS Comments: Collected By: K L . Agency Code: PWS #;______ Source ID: j Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street. S'( Street________ City/St/Zip K)."/. Citv/St/Zio Identification of Source________________________ Phone#: Fax#: Collection Point /■ T L-1;^' t," ____________ CA.CH, Bl? Check#: Amounts:

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & all others) _ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) ^Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _Zvolatile 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 (SMI 8/6630,8151)’■ ' _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI 8/6630) __ 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) / 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 (SMI8/6630) pH ___________ _UCMRList1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity .Aluminum __ Potassium __ Turbidity __ Alkalinity ^Antimony Selenium _ pH __ Bromide _Z Arsenic -/Silver' . __ Conductivity __ Bromate/Chlorate/Chlorite /Barium • ' :__ Sodium __ Corrosivity (temp;. “C) __ Chloride / 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 __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium,'Ca*2 < ■ I CLE. .. \ • __ Dissolved Oxygen __ Nitrogen, Nitrate as N _..M,etals/CN _/Chromium,'Total __ Total Organic Carbon ___Volatiles __ Nitrogen. Nitrite as N __ Chromium, Hexavalent __ Total Organic Halides Serrii-violatiles ' __ Nitrogen. Total Kjeldahl as N ACobalt __ Solids, Percent (%) _ Pesticides/PCB's •__ Oil and Grease y Copper __ .Solids, Settleable __ Phenol^ Iron __ Solids, Suspended TCLP __ Phosphorus. Total as P y Lead _^TCLR-Metals' __ Solids, Total __ f^hosphorus. Ortho as P __ Magnesium TCLP-Pesticides' ’__ ’ Solids,- Total'Dissolved __ Sulfates _£ Manganese -^TCLP.He^ibides; __ Solids,-Total Volatile Surfactants. xZ Mercury , Other: ' Z ' - •_________ .,_TCLP-V61atilesv ' UV254' / MolyMenum ._'T)C!J’-BN/Ks _ZNickel. i.*

, 1 Yi' ' NYC-WTC1o66o73457 '