Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

i f ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM tester ) nov.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595

Time/Date Set: (914)231-1620 Fax (914) 231-1772 ft? NYSrELAPNo. 10108 Form A-70 (rev. 10/01)

Samgjgjrxpe (circle one): • i (^PotablpD 3. Non Potable Treated Bottle #'s: tr; Ob 2. Non Potable 4. Other Chain of Custody? y^^Z^ZnoSjt^’TTv^ Time/Date Collected: z"' £'• ■ 0 “Z. Comments: Collected By: O CiC- VF Agency Code: PWS #:________ , Source ID:Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name nVc de Name/Company Street___ ! I, Street_________ City/SVZip City/SVZip Identification of Source. Phone#:_______ Fax#: Collection Point L I CA,CH, Bl? Check#: Amounts,

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) (hemodialysis & all others) __ Purgeable Halocarbons (624/8260) ^Volatile Halocarbons (524) Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) S^Volatile Aromatics (524) __ Cgltform MPN (priv well, raw, stp) Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) Organochlorine Pesticides (608/8081) __ Microscopic ' __ Microextractables (504) PGB's (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) ji. -Herbicides (SMI8/6630;8151) __ PCB as Decachlorobiphenyl (508A) Other Pesticides (SM,18/6630) _ API __ Other:_____________________ __ Herbicides (515) Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) Glycols in Water i Refrigerated?yes no __ Carbamate Pesticides (531) Acid Extractables (625/8270) Chlorinated:?yes no __ Glyphosate (547) _ Base Neutral Extractables (625/8270) __ Diquat (549) V/ 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 Listi j RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon ( __ Other______________ _____

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity Aluminum Potassium ■ __ Turbidity __ Alkalinity Antimony Selenium _ pH __ Bromide ^Arsenic Silver __ Conductivity __ Bromate/Chlorate/Chlorite •^Barium _ ..Sodium __ Corrosivity (temp:. .’C) __ Chloride _^Beryllium 2<sThallium. _ BOD (5 day) __ Cyanide __ Boron Vanadium __ Carbonaceous BOD (5 day) _ Fluoride ,^2<Cadmium ^^Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, .as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N Calcium, Ca*? CLE j ■ __ Dissolved Oxygen ^Chromium, Total _Metals/CN __ Nitrogen, Nitrate as N __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N ' ^Cobalt ^Copper __ Pesticides/PCB's __ Solids, Percent (%) __ Oil and Grease __ Solids, Settleable __ Phenol A Iron __ Solids, Suspended ■__ Phosphorus Total as P j;j^ead _„:TCLP-Metals ,__ Solids, Total __ Phosphorus, Ortho as P __ Magnesium ‘ — TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates 2s,t'Manganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants XMercury ■__ TCLP-Volatiles Smother: .SO_____ _ UV254 ^Molybdenum t _ TCLP-BNA’s 2S Nickel. .! -; *■ I NYC-WTC_000073550