Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

I ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■

j ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH i tv.com 2 Dana Road. Valhalla. New York 10595 1 iJ_Jnbi(K«sSh*j X i (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.10/01)'" /'7 c , , ■ T h. • K6 Ci Sample Type (circle one): Bottle #'s: (Sv C 1' ? 7' 1. Potable 3. Non Potable Treated Chain of Custody? Yes.-No C. / 2. Non Potable 4. Other ___________ I Time/Date Collected:: llb(f Comments: Collected By: Agency Code: PWS #:_______ Source ID: Type Descriptor: Collected From: Bill to: Location'^lndividual’s Name - PC Name/Company Street H cALC £ j-' H/ Street________ 1 City/St/Zip V .4 C ?• / /I L ?V >7 V < (' 9 S’" City/St/Zip Identification of Source _____________ Phone#: Fax#: Collection Point FT / C.& ________ I CA.CH. Bl? Check#:. Amounts. I BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) (hemodialysis & all others) Purgeable Halocarbons (624/8260) i X Volatile Halocarbons (524) Purgeable Aromatics (624/8260), __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) ) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) j __ Microscopic __ Microextractables (504) __ PCB’s, (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM 1.8/6630.8151) 1 _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) __ Other:_____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) _ Pesticides (525) __ Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) Acid Extractables (625/8270) Chlorinated;?yes no _ Glyphosate (547) Base .Neutral Extractables (625/8270) n __ Diquat (549) GC/MS .Unknown Scan Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS)' I Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ Other:_______ _ ___________________ t PH >----------------- _ Other Pesticides (SM18/6630) _UCMRList1 ' F^DIOCHEMICAL ANALYSIS _ MtBE Only (524) _ Radon _ .Other____________________ -s

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity ^Aluminum _ _ Potassium '__ Turbidity .__ Alkalinity VAntimony Selenium _ pH __ Bromide , Y Arsenic ..^Silver r __ Conductivity __ Bromate/Chlorate/Chlorite X Barium Sodium i __ Corrosivity (temp:. .“C) __ Chloride Beryllium 2 Thallium __ .BOD (5 day)

i __ Cyanide Boron __ Vanadium / Carbonaceous BOD (5 day) __ Fluoride ^Cadmium jXZinc y Soluble BOD (5 day) __ Hardness, Total as CaCOa _ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium. Ca+2 cue _ Metals/CN ;__ Dissolved Oxygen __ Nitrogen. Nitrate as N XChromium. Total __ Volatiles I__ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium. Hexavalent 4__ Total Organic Halides _ Semi-violatiles __ Nitrogen, Total Kjeldahl as N X Cobalt _ Pesticides/PCB’s U Y__ Solids.'Percent (%) __ Solids. Settleable __ Oil and Grease __ Phenol X Copper X Iron IfikE j)__ Solids. Suspended __ Phosphorus Total as P S Lead _TCLP-Metals s' Solids. Total __ Phosphorus, Ortho as P __ Magnesium I Total Dissolved _TCLP-Pesticldes __ Sulfates X Manganese I L ^'wlids, Total Volatile __ TCLP-HerbIcldes __ Surfactants ^Mercury Piper:. _ TCLP-Volatlles _ UV254 Molybdenum _ TCLP^BNA's __ t*. X Nickel li- ZZZaEZZZZZZZZZ tv— A NYC-WTC_000073551