Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster t iv.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 ICSIOV-w NYS-ELAP No. 10108 Time/Date Set: S>-2feq3 0-2699/ Form A-70 (rev. 10/01)

Sample Type (circle one); I (potable 3. Non Potable Treated ■ Bottle #’s: I 2. Non Potable 4. Other. Chain of Custody?___ Yes___ No I ! Time/Date Collected: ‘ H tj 2. Comments: Collected By; AC* T Agency Code: PWS #:______ Source ID: Type Descriptor: Collected From: Bill to; t Location’s/lndividual’s Name P_________ Name/Company Street V*4 C S o VY" y&T i Vf__________ Street_______ city/st/zip that \j - t fc 5 9 S~ City/St/Zip Identification of Source__________ '________________ Phone#: Fax#: Collection Point P Q (^1-^ . -________________ I CA.CH, Bl? Check#; Amounts ______________ BACTERIOLOGICAL ANALYSIS MSb#; Lab#:_______________________ organic POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count iLj^halomethanes (524) _ Purgeable Halocarbons (624/8260)' (hemodialysis & all others) __ Coliform P/A (Public supplies) ■jLkCVolatile Halocarbons (524) ___ Purgeable Aromatics (624/8260) __ Coliform MPN (priv well, raw, stp) '4^^latile Aromatics (524) __ Aprolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Orga nochlorine.Pesticides(608/8081) __ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) __ Macroscopic Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) ! _ API _2-PCB as Decachlorobiphenyl (508A) . _ Other Pesticides (SM18/6630) __ Other:_____________________ ___Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) ' __ Glycols in Water Refrigerated?yes no _Carbaniate Pesticides (531) _ Acid E'xtractahles (625/8270) Chlorinated:?yes___ no __ Glyphosate (547) _ Base Neutral Extractables (625/8270) ■_1 Diquat (549) j/GC/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 (SMI8/6630) pH ------------------- _ UCMR List 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) ' "---------------------------------------------- __ .Radon __ Other_____________________

I INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity _ix*^luminum __ ^tassium __ Turbidity __ Alkalinity L>^ntimonv j/Selenium _ pH __ Bromide _ii^senic ju*8irver. __ Conductivity __ Bromate/Chlorate/Chlorite _s;f^rium __ ^dium __ Corrosivity (temp:_____ ®C) __ Chloride _*;^ryllium _u/Thal!ium _■ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD’ (6 day) __ Fluoride .k^Oadmium 4Z^inc _ Soluble BOD (5 day) Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ CLE __ Dissolved Oxygen * __ Nitrogen, Nitrate as N ji:<5hrpmium, Total. • _Metals/CN __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Ctjromium, Hexavalent __ Total Organic Halides _fer^balt __ Semi-violatiles ___Nitrogen, Total Kjeldahl as N .__ Solids, Percent (%) _ Pesticides/PCB’s' __ Oil and Grease j-*&pper '__ Solids, Settipable __ Phenol J^Tran __ Solids, Suspended /'__ ' Phosphorus Total as P _fc<ead ICLE __ Solids, Total _TCLP-Metals __ Phosphorus, Ortho as P _ Magnesium __ Solids, Total Dissolved __ Sul/ates __ TCLP-Pesticides / j^T^anganese ySblids, Total Volatile __ Surfactants _-TCLP-Herbicides Ol^ercury _ TCLP-Volatiles Other; _ UV254 .i^rlMolybdenum __-TCLP-BNAs .t^ickel

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