Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document -J. "r ■'MV jit ? 1 '=-‘' S -I '

■V ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

iSl^' t WESTCHESTER COUNTY. LABORATORIES AND, RESEARCH 2 Dana Road,.Valhalla, New York 10595,. (914) 231-1620 Fax (9J4)'231-1772 • 1 - jwrr Cv’M.

Tr— ' x 4 NYS-ELAP No. 10108. -‘’I fime/bate Set: Form A-70 (rev.lO/Olf f »

Sample Type (circle one): V / , 7 7/ z, J i ?. 1. Potable 3. Non Potable'Treafed Bottle‘#’s: 'S 2. Non Potable 4. Other Chain of Custody?____ Yes No f- 'I Time/Date Collected:: ' Collected By: A_ Agency Code: ■3'/ Z •/ r 2. Comments: PWS #:_____________ Source ID: Type Descriptor: I ^Collected From: Location’s/lndividual's Name '* t , J . 7 Bill to: Name/Company <■ 'i' i '17' I 7..1-

Street'________________ Street • City/St/Zip: City/St/Zip__________ _ lijentification of Source Fax#: ‘Collection Point Phone#: - 1 1

BACTERIOLOGICAL ANALYSIS Lab#: ( Lab#: CA,CH,‘ Bl? 2 'Check#:

ORGANIC NONPOTABLE/ SOLID ANALYSIS J Amounts ' . J. 4 3J ORGANIC POTABLE ANALYSIS __ Heterotrophic Plate Count __ frihalomethanes (524) •f?' (hemodialysis & all others) __ Purgeable Halocarbons (624/8260): __ Coliform P/A, (Public supplies) __ Volatile Halocarbons (524) ,_L_ Purgeable Aromatics (624/8260) J __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) Volatile Aromatics (524) __ Total Trihalomethane Potential (510) • ___ Acrolein & Acrylonitrile ’(8260) J '__ Organochlorine Pesticides (608/8081) .'■J. I 1 ’__ Microscopic __ Macroscopic _ API, __ Microextractables (504) __ Pesticides/PCB screen (508) __ PCB as Decachlorobiphenyl (508A) _ PCB’s (Arochlors) (608/8081) _ Herbicides (SM18/6630,8151) _ Other Pesticides (SM18/6630) , ' I. 1 I _ Other: i. __ Herbicides (515) Petroleum Hydrocarbon Scan (310-13)'it' Pesticides (525) ■ ^Glycols in Water j f Refrigerated?yes no __ Carbamate Pesticides (531) ' _ Acid Extractables. (625/8270) I I I Chlorinated:? Free Chlorine Res:mg/L yes‘no __ Glyphosate (547) _ Diquat (549) __ Chlorination Disinfection Byproducts (551) __ Base Neutral Extractables (625/8270) - i./i __ /-g6/MS Unknown'Scan __ Phthalates (606MS) ' 1 ' J.M 1 Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other: - ■g pH __________ __ Other Pesticides (SM18/6630) ■; -it. a RADIOCHEMICAL ANALYSIS __ ^Radon _ other ,_UCMRList 1 ’ _ MtBE Only (524) I

'<57 ■. i'Z i ^45. 1’■ INORGANIC ANALYSIS REQUESTED - Lab#: i' •//: -'7 V ’• ___ Color • ' _ Acidity JJ:"Aluminum __ Potassium I ¥ __ Turbidity » __ Alkalinity XAntimonv '■■Selenium — pH ". (__ Bromide ’’ _£fSilver , I Arsenic _ ; Conductivity" . __ Bromate/Chlorate/Chlorite "'Barium __ Sodium, __ Corrosivity (temp:______ °C), ' _ BOD (5 day)’ __ Chloride __ Cyanide t _~Beryllium __ Boron >. •_uTh'allium '■ __ Vanadium 71 .r •1 _ Carbonaceous BOD (5 day) _ Soluble BOD ’ (5 day)' _ Fluoride 1 Hardness, Total as CaCOa ■ __ Cadmium __ Calcium, as CaCOa • Ji" Zinc CLP " "I __ Chemical Oxygen Demand __ 'Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Metals/CN V '5; ,__ Dissolved Oxygen _i Nitrogen, Nitrate as N jjiChromium, Total __ Volatiles , _si Total Organic Carbon __( Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles ‘ __ ' Total Organic Halides __ Nitrogen, Total Kjeldahl as N _:;Cobalt ! _ Solids, Percent (%) * _ Pesticides/PCB’s ■4 __ Oil and Grease . ^■Cooper

t __ Solids, Settleable _ Solids, Suspended __ Solids, Total __ Solids, Total Dissolved __ Solids, Total Volatile __ Phenol ___Phosphorus total as P •__ Phosphorus, Ortho as P __ Sulfates ‘__ Surfactants '■■'Iron JJLead __ Magnesium _L-Manganese » 1 TCLP _TCLP-Metals ___TCLP-Pesticides _TCLP-Herbicides I

I 31 ,• tr'"Other: _____________ _ UV254 A ^■Mercury ‘_l’'Molybdenum _ TCLP-Volatiles 'M __ 'TCLP-BNA's f ft. ■1 ... ■- _______________ Nickel I '■ NYC-WTC_000073480