Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2’Dana,. Roadj Valhalla, New York 10595 L. (9'14) 231-1620 Fax (914) 231-1772 NYS-ELAP No.-10108'' -< Time/Date Set: '* . ST , , Form A-70 (rev.10/01),v.-

Sample Type, (circle one): 3. Non Potable Treated ' ■ -I-' I 1. Potable Bottle #’s: 1 I • 2. Non Potable 4. Other________ Chain of Custody?___ Yes No V. f . t ‘-V'- Time/Date Collected: Comments:’ ■"5 Collected By: Agency Code: PWS #: _______ Source ID: Type Descriptor:'' ■

Collected From: Bill to: ,1 Y Location’s/lndividual's Name Name/Company Street 2 Street ____ t City/St/Zip________________ City/St/Zip !■ 3 Identification of Source Phone#: Fax#: 5 I Collection Point - CA,CH, Bl? Check#:'. Amount$_A

BACTERIOLOGICAL ANALYSIS Lab#:________________ Lab#: .. .. ■ i /Y 3 ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate,Count __ Trihalomethanes (524) ’ (hemodialysis & all others) __ Purgeable Halocarbons (624/8260) , Y __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/826(3) ' , __ Coliform MPN (priv well,-raw, stp). __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) ji ■.'j; ’ __ Fecal Coliform (all samples) Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081)^ /'i ___ Microscopic __ Microextractables (504) ?■ . _ PCB’s (Arochlors) (608/8081) __ .' Macroscopic _ API • _ Pesticides/PCB'screen (508) __ PCB as Decachlorobiphenyl (508A) Herbicides (SM18/6630,8151) ' — .Other Pesticides (SMI8/6630) . f f T-Y. I ■__ Other: __2___________ .. __.Herbicides (515) __ Pesticides (525) ' __ Petroleum Hydrocarbon Scan (31(3-13), 7Y- _ Glycols in Water J. v 'y... I I Refrigerated?yes ___ no Chlorinated:?yes"___ no ■ __ Carbamate Pesticides (531)- __ Glyphosate (547) __ Diquat (549) ’ ’ Acid Extractables (625/8270) ; "-f?- __ Base Neutral Extractables (625/8270) ''S;.. __;''GC/MS Unknown Scan ' M I Free Chlorine Res:’ Total Chlorine Res:mg/L mg/L __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) _ Phthalates (606MS) Jl Other:1t k , I __ Other Pes'ticides (SM18/6630) pH _____________ W- RADIOCHEMICAL ANALYSIS _ UCMR List 1 _MtBE Only (524). r I ___ Radon I ___ Other_______________

INORGANIC ANALYSIS REQUESTED - Lab#: . zn ^•1 __ Color __ /'cidity _ Aluminum __ Potassium _ Turbidity _■ Alkalinity __ .Antimony _:_.Selenium • I’ ■— pH ■__ Bromide ' Arsenic. _i_- Silver , _ Conductivity __ Bromate/Chlorafe/Chlorite .2_ Barium Sodium . Corrosivity (temp:. .°C) _ Chloride Beryllium Thallium I • 1 _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous,BOD (5 day) _ Soluble BOD (5 day) __ Fluoride __ Hardness, Total as CaCOs __ Cadmium __ Calcium, as CaCOa Zinc 3 __ Chemical Oxygen Demand CLP i __ Nitrogen, Ammonia as N __ Calcium, Ca*2 _ _ Dissolved Oxygen _ Metals/CN __ Nitrogen, Nitrate as N '__ Chromium, Total __ Total Organic Carbon _ _ Volatiles __ Nitrogen, Nitrite as N _ Chromium, Hexavalent __ Total Organic Halides Semi-violatiles j. Nitrogen, Total Kjeldahl as N Cobalt __ Solids, Percent (%) __ Pesticides/PCB's _ Oil and Grease " __ .Copper __ Solids, Settleable Phenol — Iron TCLP

1 __ Solids, Suspended __ Phosphorus Total as P __1 Lead __ Solids, Total __ TCLP-Metals" I __ 1 Phosphorus, Ortho as P ___ Magnesium _ Solids, Total Dissolved •__ TCLP-Pesticides __ Sulfates _1_ Manganese ___ Solids, Total Volatile __ TCLPrHerbicides __ Surfactants __ Mercury ’ _i_ Other:____________________ _ TCLP-Volatiles * — UV254 __ Molybdenum ’ _ TCLP-BNA’s I ___ Nickel ■|:

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