Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

Ty7 ENVIRONMENTAL SERVICB^.SAMPLE SpBlVilSiSioN FORM ' " '51 sster WESTCHESTER COUNTY LABbRATORlES AND RESEARCH ?v(Dom 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 x ... NYS^APTIon0l08 ■ Time/Daie Set: FowXA-70 (rev 10/01)

Sample Type (circle one): ^j^otable 3, Non Potable Treated Bottle rs Or- 1 2. Non Potable 4. Other | f Chain of Custody?___ Yes____ No t Time/Date Collerted:. Comments: Collected By: . Agency Code: PWS #:_______ Source ID; Type Descriptor: Collected From;' Bill to; Location's/lndividual’s Name Name/Company I Street____________________ Street________ City/St/Zip________________ City/St/Zip Identificanon ot Source Phone#: Faxff: Collection Point ^0^ CA,CH, Bl? Check#: Amounts. I

I BACTERIOLOGICAL ANALYSIS Lab#: Lat>#:________________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) __ Pungeable Halocarbons (624/8260) __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform MPN (priv well, raw. stp) __ Volatile Aromatics (524) __ Acrolein & Aciy'lonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8001) __ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI8/6630) __ Other:_______________________ _ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water ! Refrigerated?yes. no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) I Chlorinated:?yes no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) __ Diquat (549) Iz^C/MS Unknown Scan Free Chlorine Res: . rng/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) Total Chlorine Res: . rng/L __ Haloacetic Acids (552) __ Other:______________________________ _ _ Other Pesticides (SMIS/6630) pH ____________ _UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBEOnly (524) I__ Radon __ Other_______________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity '"^jiluminum __ Potassium ' __ Turbidity __ Alkalinity ■^^^^timony i^^elenium t _ pH __ Bromide ■-^^rsenic Silver __ Conductivity (__ Bromate/Chlorate/Chlorite ✓Soanum __ ^dium __ Corrosivity (temp:. ’C) __ Chloride Beryllium t ZThallium _ BOD (5 day) __ Cyanide __ Boron __ ^j»adium _ Carbonaceous BOD ‘ (5 day) __ Fluoride __ Cadmium __ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOj CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*’ vz^hromium, Total _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Volatiles __ Total Organic Carbon __ Nitrogen. Nitrite as N __ Chromium, Hexavalent s-^obalt __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N i:^opper __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease __ Solids. Settleable __ Phenol •^Iron __ Solids, Suspended __ Phosphorus Total as P Lead I£kE _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P _ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates L z^nqanese >S6iids. Total Volatile _TCLP-Herbicides __ Surfactants Other: _ TCLP-Volatiles _ UV254 ^XMolvbdenum ^Nickel _ TCLP-BNAs

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