Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION ’ tester WESTCHESTER COUNTY J-ABORATORIES AND RESEARCH ' ' ' [ovcom 2 Dana Road, Valhalla, New York 10595 ( (914)231-1620 Fax (914) 231-1772 s x ’ [ }[ ^NYS-ELAP No. 10108 Time/Date Set: ______________ ' P'i^b k y ^mA-70(rev.10/01) Y

Sample Type (circle one): 0? Potable 3. Non Potable Treated Bottle #’s: 2. Non Potable 4. Other____________ Chain of Custody? Yes No Time/Date Collected: Comments: ___ Collected By: L- Agency Code: PWS #: _____ Source ID: Type Descriptor: Collected From: Bill to: Location's/lndividual’s Name _ Name/Company Street Street__________ _ City/St/Zip iZa / IZ City/St/Zip i Identification of Source Phone#:________ _ Fax#:' Collection Point fL/Xf I CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID. ANALYSIS $ __ Heterotrophic Plate Count __ Tjihalomethanes (524) 1 (hemodialysis & all others) __ Purgeable Halocarbons (624/8260) __ Coliform P/A (Public supplies) ld<volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) Lz<?olatile Aromatics (524) _ Acrolein. & Acrylonitrile (8260) __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Orgariochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) _ PCB’s.(Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) Herbicides (SMI8/6630,8151) I _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI8/6630) 1_ Other:__________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water J Refrigerated?yes no __ Carbamate Pesticides (531) _1 Acid Extractables (625/8270) Chlorinated:?yes___ no __ Glyphosate (547) _ ^se Neutral Extractables (625/8270) _ Diquat (549) _2>dc/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) Other:___________________________ pH * _Other Pesticides (SMI8/6630) _UCMR List1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon __ Other____________________ XT I INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity iZ**Aluminum __ Potassium __ Turbidity __ Alkalinity J^^^nt^mony jX^lenium _ pH. • __ Bromide X^rsenic _^ilver i __ Conductivity __ Bromate/Chlorate/Chlorite Jij^arium dium __ Corrosivity (temp: “C) __ Chloride jXBeryllium allium _ BOD (5 day) __ Cyanide oron __ ^fiadium __ Carbonaceous BOD (5 day) __ Fluoride admium _t^nc _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N OLE ■ __ Calcium, Ca+2 _ Metals/CN I __ Dissolved Oxygen __ Nitrogen, Nitrate as N .kfChromium, Total _ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ ^Chromium, Hexavalent ___ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N t<yobalt ! I^opper _ L Pesticides/PCB’s __ Solids, Percent (%) _ Oil and Grease I __ Solids, Settleable __ Phenol jZjfon ISLE __ Solids, Suspended __ Phosphorus Total as P _<lead __ TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P Magnesium j/^anganese _TCLP-Pesticides __ Solids. Total Dissolved __ Sulfates _TCLP-Herbicides __ Solids, Total Volatile __ Surfactants _^ercury jX^ther: ___________ __ TCLP-Volatiles _ UV254 _X^olybdenum _j/Nick'el _ TCLP-BNA’s

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