Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document 1 t 1 7 ’■'W ACCo ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 1.1 *1^ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 ^4 /!1

NYS-ELAP No' joiosf Time/D'ate Set: Form A-70 (rev.10/dl );

Sarhple Type (circle one):. "4 J Bottle #’s: J

s 1. Potable ' 3. Non Potable Treated 2. Non Potable Time/Date Collected: 4. Other Chain of Custody? Comments: Yes___ No -. "i: ■ . I Collected By:_____________ Agency Code: PWS #: _r_____ _ Source ID:Type Descriptor: Collected From: >4 Bill to: '"..Y Location's/lndividual’s Name Name/Company _ I. Street____________________ Street_______ “ 1- City/St/Zip ' City/St/Zip ‘.

S id Identification of Source Phone#: _____ Fax#: • V

Collection Point

BACTERIOLOGICAL ANALYSIS Lab#: CA.CH, Bl? Check#: Amounts I Lab#: .__________________ fl I __ Heterotrophic Plate Count (hemodialysis & all others) ORGANIC POTABLE ANALYSIS __ Trihalomethanes (524) ORGANIC NONPOTABLE/SOLID ANALYSIS' __ Purgeable Halocarbons (624/8260) ' i __ Volatile Halocarbons (524)' __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) __ Volatile Aromatics (524) __ Total Trihalomethane Potential (510) ■ Acrolein & Acrylonitrile (8260) f __ -Organochlorine Pesticides (608/8081) ' VfrV'f I .viil __ Microextractables (504) PCB’s (Arochlors) (608/8081) __ Microscopic _ Macroscopic __ Pesticides/PCB screen (508) '\ _ Herbicides (SMI8/6630,8151) ■I __ PCB as Decachlorobiphenyl (508A) \ _. Other Pesticides (SMI8/6630) _ API

i __ Other: ___ _____ ,______________

Refrigerated?yes___ no Chlorinated:? yes ___ no __ Herbicides (515) __ Pesticides (525) __ Carbamate Pesticides (531) __ Glyphosate (547) __ Diquat (549) ■■ __ Petroleum Hydrocarbon Scan (310-13) ’ j: ___ Glycols in Water _‘Acid Extractables (625/8270) ,.Base Neutral Extractables (625/8270),., GC/MS Unknown Scan 1 W

i Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) Phthalates (606MS) I I ■ Haloacetic Acids (552)*' 4 Total Chlorine Res: pH _____________ mg/L __ Other Pesticides'(SMI 8/6630) _ UCMR List 1 ’■ ‘ ___ Other:^^^^j,____

I ■ J RADIOCHEMICAL ANALYSIS ___ Radon __ MtBE Only (524) J ■ I •' I f __ Other L:--------- ;------ -

INORGANIC ANALYSIS REQUESTED - Lab#: I __ Color __ Acidity Aluminum .__ Potassium __ Turbidity __ Alkalinity __ Antimony ■R __ Selenium — pH '■ , _ Bromide __ Arsenic __ Silver s ■>

__ Conductivity J. __ Bromate/Chlorate/Chlorite __ Barium __ Sodium __ Corrosivity (temp:. “C) __ Chloride __ Beryllium __ thallium

I _ BOD (5 day) __ Carbonaceous BOD (5 day) __ Cyanide t __ Boron _ Vanadium' w I __ Fluoride .__ Cadmium __ Zinc _ Soluble BOD (5 day) * Hardness, Total as CaCOs __ Calcium, as CaCOs ■CLP __ r Cherfiical Oxygen Demand __ Nitrogen, Ammonia as N .__ Calcium, Ca*2 > __ Dissolved Oxygen _ Metals/CN 1 __ Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles ' 1 __ Total Organic Carbon *- __ Nitrogen, Nitrite as N __ Chromium, Hexavalent' __ Total Organic Halides > __ Semi-violatiles , 1 __ Nitrogen, Total Kjeldahl as N __ Cobalt '__ Solids, Percent’(%) _ Oil and Grease _ ;Copper ___ Pesticides/PCB’s •5 Solids, Settleable t __ Phenol • _L Iron TCLP ■J __ Solids, Suspended __ Solids, Total __ Phosphorus Total as P __ Phosphorus, Ortho as P _Lead * __ Magnesium _TCLP-Metals , I "4 TCLP-Pesticldes ___ Solids, Total Dissolved . __ Sulfates 2_ Manganese I ■i __ .Solids, Total Volatile __ Surfactants __ Mercury __ TCLP-HerbIcldes __Other: _________ __________ _ UV254 __ Molybdenum ___ TCLP-Volatiles ' "A _ TCLP-BNA’s __ Nickel J’ L NYC-WTC_000073481