Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

■/iU. ACOn. ' ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM . ster ivcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 wy^ELAPNo. 10108 Time/Date Set: Xporm A-70 (rev. 10/01)

Sample Type (circle one); 1. Potable 3. Non Potable Treated Bottle #’s: ( Potable 4. Other Chain of Custody?Yes___ No ^Time/Date Collected: Comments: Collected By:_____ j _ Agency Code: PWS #:______ Source ID: Type Descriptor: Collected From: Location’s/lndividual’s Name Street_______________ _ )' (J Bill to: Name/Company Street_______ p City/SVZip______________ City/SVZip 1 Identification of Source Phone#: Fax#: J 1 4* Collection Point I CA,CH, Bl? Check#: Amounts. I r BACTERIOLOGICAL ANALYSIS Lab#; I Lab#:_______________________ _ Heterotrophic Plate Count ORGANIC POTABLE ANALYSIS ■' ORGANIC NONPOTABLE/SOLID ANALYSIS (hemodialysis & all others) __ Trihalomethanes (524) ■ __ Purgeable 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 & Acrylonitrile (8260) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) t. __ Fecal Coliform (all samples) __ Microextractables (504) PCB’s (Arochlors) (608/8081) __ Microscopic k __ Macroscopic _ API __ Pesticides/PCB screen (508) __ PCB as Decachlorobiphenyl (508A) _ Herbicides (SM18/6630,8i51) __ Other Pesticides (SM18/6630) __ Other:_____________________ __ Herbicides (515) _ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water r Refrigerated?yes___ no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) ht Chlorinated:?yes___ no __ Glyphosate (547) __ Diquat (549) Base Neutral Extractables (625/8270) ^,^,,^,»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____________________ 1 INORGANIC ANALYSIS REQUESTED - Lab#; ._ ___ r __ Color __ Aiidity ■ Aluminum __ Potassium

i __ Turbidity — pH ___ Conductivity __ Alkalinity __ Bromide _ _ Bromate/Chlorate/Chlorite _ 1 Antimony __ Arsenic __ Barium __ Selenium __ Silver ■ __ Sodium __ Corrosivity (temp: ’C) __ Chloride _ _Beryllium __ Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium __ Zinc I _ Soluble BOD (5 day) __ Hardness, Total as CaCOa _ Calcium, as CaCOs “CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ ■ i

__ Dissolved Oxygen _ Metals/CN __ Nitrogen, Nitrate as N __ Chromium, Total __ Total Organic Carbon __ Volatiles __ Nitrogen, Nitrite as N __ Chromium, Hexavalent ■__ Total Organic Halides __ Semi-violatiles __ Nitrogen, Total Kjeldahl as N __ Cobalt __ Solids, Percent (%) __ Pesticides/PCB’s __ Oil and Grease __ Copper 1 __ Solids, Settleable __ Phenol __ Iron __ Solids, Suspended __ Phosphorus Total as P __ Lead I£LE 4 _ Solids, Total _TCLP-Metals I _ Phosphorus, Ortho as P __ Magnesium __ Solids, Total Dissolved __ TCLP-Pesticides __ Sulfates __ Manganese _ : Solids, Total Volatile __ TCLP-Herbicides __ Surfactants __ Mercury __ Other: _________________ _ TCLP-Volatiles _ UV254 __ Molybdenum _ TCLP-BNAs __ Nickel

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