Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM a lester WESTCHESTER COUNTY LABORATORIES AND RESEARCH Bjov.com 2Dana Road, Valhalla, New York 10595, ' ., o, (914)231-1620 Fax (914) 231-1772 , . . 11-• NY0LAP No. 10108' Time/Date Set: Fo(WA-70 (rev.'lO/OI)

Sample Type (circle one): 1. Potable 3. Non Potable Treated Bottle #’s: i^^Non Potable 4. Other Chain of Custody? Yes.No Time/Date Collected: ■ Comments: Collected By: Agency PWS #:________ Source ID: Type Descriptor: Collected From: Bill to; Location’s/lndividual's Name Name/Company Street_________________ Street_________ City/St/Zip______________ City/St/Zip Identification of Source Phone#:_______ Fax#: Collection Point I CA,CH, Bl? Check#; Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodiaiysis & ali others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ 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 (SMI 8/6630,8151) . . _ 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) ?S±r-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 ___________ _UCMR Listi RADIOCHEMICAL ANALYSIS _MtBE Only (524) __ Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity _ Aluminum _ Potassium __ Turbidity __ Alkalinity jL Antimony ' . . ,__ Selenium , _ pH __ Bromide __ 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 CaC03 - __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^, - £!.£ ■ __ Dissolved Oxygen __ ■ Nitrogen, Nitrate as N ._ Metals/CN .. __ Chromium, Total __ Total Organic Carbon __ Volatiles ■ __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Total Organic Halides _ Semi-violatiies __ Nitrogen, Total Kjeldahl as N __ Cobalt ■ __ Solids, Percent (%) r __ Pesticides/P,CB’s __ Oil and Grease __ Copper __ Solids, Settleable __ Phenol __ Iron ■ Solids, Suspended ' _ Phosphorus .Total as P __ Lead ickP •_:TCLP,-Metals,.; __ . Solids, Total __ PtiospKorus, Ortho as P' __ Magnesium"; __ Solids, Total Dissolved ;__ Sulfates i ' ’ _ :TCLP-Pesticides __ : Manganese 1_TCLP-Herbicides’ L_ Solids, Total.Volatilej ' Surfactants; __ Mercury, I. • ■

_ U\^4^ ' - TCLP,-Volatiles^ Other: ■ ^Molybdenum _ TCLP-BNA^: “-"NickeL

NYC-WTC_000073458