Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

I tester ENVIRONMENTAL SERVICES SAMPLE SUBMISSIONzR0ffSC -8 A I rov.com »; WESTCHESTER COUNTY LABORATORIES AND RESEARCH % 2 Dana Road, Valhalla, New York 10595 V (814)231-1620 Fax (914) 231-1772 ^^YS-ELAP No. 10108 Time/Daie Set; / Form A-70 (rev.10/0l) I

plc Type ^circle one); I otable 3. Non Potable Treated Bottle #'s: - I fe I ? '2-70 1 2. Non Potable 4. Other _ ___________ Chain of Custody?___ Yes____ No Time/Date Collected; Comments:______________________ I Collected By: Agency Code; PWS #:_______ Source ID: .Type Descriptor;

I Collected From: Bill to: Location's/lndividual’s Name Name/Company Street___________________ Street________ City/St/2ip________________ City/SVZip Identification of Source Phone#: Fax#: f Collection Point CA.CH, Bl? Check#; Amounts.

BACTERIOLOGICAL ANALYSIS Lab#; Lab#:__________ _______________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/6260) I- __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform MPN (phv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Colifonn (all samples) __ Total Trihalomethane Potential (510) __ Organochlorins Pesticides (608/8031) __ Microscopic __ Microextractables (504) __ PCB's (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) __ Other_______________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) t __ Pesticides (525) __ Glycols in Water Refrigerated?____ yes____ no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) Chlorinated:?yes no __ Glyphosate (547) __ Sas# Neutral Extractables (625/8270) __ Diquat (549) Jr'iJC/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Adds (552) __ Other:__________________________ _ __ Other Pesticides (SM18/6630) pH ____________ __ UCMR List 1 RADIOCHEMICAL ANALYSIS __ MtBE Only (524) __ Radon __ Other_______________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity luminum __ Potassium __ Turbidity __ Alkalinity timony ^trS^enium — pH __ Bromide ;enic p^ver __ Conductivity __ Bromate/Chlorate/Chlorite .^fBarium __ Sodium __ Corrosivity' (temp:, ."C) __ Chloride _t^eryllium XefTfiallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium _^x2inc _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand £kP __ Nitrogen, Ammonia as N _ C^ium, Ca’2 j<^omium. Total __ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chj'omium, Hexavalent __ Semi-violatiles __ Total Organic Halides ■ Nitrogen, Total Kjeldahl as N _jt<Cobalt __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease 2:^opper __ Solids, Settleable __ Phenol _i:<ron __ Solids, Suspended __ Phosphorus Total as P _t;^Eead TCLP _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates XsH^anganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants *-~1^ercurY _ TCLP-Volatiles —dtiier: _________ __ UV254 j:;ftoyt)denum _r1^ckel __ TCLP-BNAs

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