Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

203Z FEB - 8 A IQ: 18- ‘■".I b

n fester IT ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ov.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 A a.

(914) 231-1620 rax (914) 231-1772 /piYS-ELAP No, 10108 Time/Date Set; ) S,ample Type (circle one): Quotable 3. Non Potable Treated C-iUo Bottle #'s: 2. Non Potable 4. Other________________________ Chain of Custody?___ Yes___ No I Time/Date Collected: I(/J-T Comments: Collected By; -F"» C^-<S.SPV7Yi6.l> Agency Code; PWS #:______ Source ID: Type Descnptor: Collected From: Bill to: Location’s/lndividual's Name 0 Lk3l2- Name/Company Street_________________ Street_______ City/SVZip_____________ City/SVZip Identification oT Source Phone#: Fax#: Collection Point 55,3^ CA.CH, Bl? Check#; Amounts

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS I __Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/3260) __ 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 Colifomi (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) _ PCB's (Arochlors) (608/8081) __Macroscopic __ Pesticides/PCB screen (SOS) _ Herbicides (SMI3/6630,8151) _ API __ PCB as Oecachlorobiphenyl (506A) _ Other Pesticides (SM1B/6630) __ Other:____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water Refrigerated?yes___ no __ Carbamate Pesticides (531) __ Acid Extracts bles (625/8270) Chlorinated:?yes___ no __ Glyphosate (547) _^se Neutral Extractables (625/8270) __ Diquat (549) V^C/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 (SM18/6630) pH ___________ _UCMRList 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon __ Other___________________

INORGANIC ANALYSIS REQUESTED - Lab#; __ Color __ Acidity luminum __ ^tassium __ Turbidity __ Alkalinity ntimony u^elenium _ pH __ Bromide rsenic _>Sllver __ Conductivity __ Bromate/Chlorate/Chlorite arium __ ^dium __ Corrosivity (temp:. .’C) __ Chloride Beryllium _J<fhaHium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium lY^inc _ Soluble BOD (5 day) __ Hardness. Total as CaCOs __ Calcium, as CaCO: CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N Calcium. Ca*-’ 3^hromium, Total __ Metais/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N _ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrile as N __ premium. Hexavalent _3Xobalt __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease A/COpper __ Solids. Settleable __ Phenol TCLP __ Solids, Suspended __ Phosphorus Total as P jZLead _TCLP-Metals _ Solids, Total __ Phosphorus, Ortho as P _ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates '^Manganese ^^ercury __ TCLP-Herbicides ' / Solids, Tot^Volatile __ Surfactants Other: Q h__________ _ TCLP-Volatiles _ UV254 2^Molybdenum __ TCLP-BNA’s Nickel I ;ri'H nT:R Tim ft 03 4 RRCQ-cAC-RT>i-T:xe4 api uounaijTsin Tim NYC-WTC_000073503