Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document V r I

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM J .JVestGhester' WESTCHESTER COUNTY LABORATORIES AND RESEARCH .-1

I’ 2 Dana Road, Valhalla, Nevv York 10595 (914)231-1620 Fax (914) 231-1772 /h 1 S I si NYS-EL/\P'No. 10108' 4 i Time/Date Set: Form A-70 (reV10/01)' "d ____ i_____ Sample Type (circle one): ' 1.Potable 4 3. Non Potable Treated Bottle #’s;<2iL£L_ 'I•4 2. Non Potable' 4. Other Chain of Custody? Yes No ^Time/Date Collected; Comments: ■'irB'/? Agency Code; Type Descriptor: " Collected By: ■ -- PWS #:_________ Source ID: Collected.From: ■ Bill to: Location’s/lndividual's Name -« Name/Company st By

Street______________________ City/St/Zip _ ________________ - Street__________ City/St/Zip I

4., .a Identification of Source Phone#: _____ Fax#: Collection Point CA,CH, Bl? Check#: Amounts,

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:___________________ _______ ORGANIC POTABLE ANALYSIS ORGANIC NON POTABLE/SOLID ANALYSIS' __ Heterotrophic Plate Count „ (hemodialysis & all others) ' __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Trihalomethanes (524)' __ Volatile Halocarbons (524) __ Volatile Aromatics (524) ' '__ Purgeable Halocarbons (624/8260) t tt •? _ Purgeable Aromatics (624/8260) __ Acrolein & Acrylonitrile (8260) } ■ ' ■( I __ Fecal Coliform (all samples) __ Microscopic __ Total Trihalomethane Potential ,(510) __ Microextractables (504) t __ Organochlorine Pesticides (608/8081) _ PCB’s (Arochlors) (608/8081) ' , " B ■ fl. __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151)[ ■)- __ PCB as Decachlorobiphenyl (508A) , __ Other Pesticides (SMI8/6630) ’ ■ API __ Other: ■ ■ __ Herbicides (515) , Petroleum Hydrocarbon Scan (310-13) , a _ Pesticides (525) __ Glycols in,Water ' ’ , ' Refrigerated?yes no Chlorinated:? yes no __ Carbamate Pesticides (531) __ Glyphosate (547) . ___Acid Extractables (625/8270) -j _ Base Neutral Extractables (625/8270)'' I Free Chlorine Res: Total Chlorine Res: . mg/L- . mg/L __ Diquat (549) __ Chlorination Disinfection Byproducts (551) __ Haloacetic'Acids (552) i _s:GC/MS Unknown Scan __ Phthalates (606MS) __ Other:2__________ __ I i ’__ ..Other Pesticides (SM18/6630) pH ______ ______ _UCMRList1 ' '■ 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) 1 J___Radon __ Other .._________ ______ ---- ---- ,. ~ J ' . . s INORGANIC ANALYSIS REQUESTED - Lab#: i __ Color __ Turbidity — pH . I __ Acidity __ Alkalinity I __ ^Aluminum __ ('Antimony* ■■ • ; __ Potassium - Selenium a A Bromide Arsenic ; Silver __ Conductivity Bromate/Chlorate/Chlorite Barium __ Sodium i: ■ '■'i

r__ 'Corrosivity ■■(temp: “C)

I Chloride _ -Beryllium ‘ __ Thallium I. . 1 - , ’ _ bod (5 day) - Cyanide ' __ Boron __ Vanadium * '■ '

'__ Carbonaceous BOD’ (5 day) ,__ Fluoride __ Cadmium --Zinc 5__ Soluble BOD (5 day) ___ Hardness, Total as CaCOs __ Calcium, as CaCOa , CLP •I ■Y __ Chemical Oxygen Demand - Nitrogen, Ammonia as N ___ Calcium, Ca*^ __ Metals/CN ► ■__ Dissolved Oxygen __ Nitrogen, Nitrate as N j:l.Chromium, Total __ ■ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent _ Total Organic Halides _ Nitrogen, Total Kjeldahl as N __ Cobalt _ Semi-violatiles __ Pesticides/PCB’s 1 __ ■ Solids, Percent (%) , . __ Oil and Grease _ Copper -__ Solids, Settleable ,__ Solids, Suspended __ Solids, Total __ Phenol __ Phosphorus Total as P __ ■ Phosphorus, Ortho as P Iron Lead __ Magnesium ICLP - ’ _TCLP-Metals __ TCLP-Pesticides I'; ■■ 1' 1 I ■■ 5 ■__ Solids,-total Dissolved __ Sulfates , _ Manganese __ TCLP-Herbicides ’__ Solids, Total Volatile __ Surfactants ' .■ Mercury __ TCLP-Volatiles Other: Oz t __ UV254 Molybdenum _ TCLP-BNA's ' ■>:

Nickel 77 iS; NYC-WTC_000073477