Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ,Afestchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 ’ T ■ ■I o // l I (914)231-1620 Fax (914) 231-1772 । 1 I NYS-ELAP No. 10108 Time/Date Set: I ' L Form A-70 (rev. 10/01)

Sample Type (circle one): : ?■ J

t ■’ r A. Potable 3. Non Potable Treated Bottle #’s: ’t

2. Non Potable '4. Other _ ____________ Chain of Custody? Yes’No I

Time/Date Collected: ' Comments: % Collected By: L Agency Code: PWS #: J. I Source ID: t Type Descriptor: Bill to; ' ' ' ■<

Collected From: Location’s/lndividual’s Name - (,/ > n Name/Company 4 t Street * ■ .■ Street_________ 1

City/St/Zip : City/St/Zip Identification of Source Phone#: V f 1 .J. _ Fax#: "1 li Collection Point •’ I CA.CH, Bl? 2 Check#: Amounts

BACTERIOLOGICAL ANALYSIS - Lab#: .2. T 7

Lab#:"__________ ______________ . h'L ' 1 ORGANIC POTABLE ANALYSIS ‘ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) Purgeable Halocarbons (624/8260) (hemodialysis & all others) i __ Volatile Halocarbons (524)^ __ --Purgeable Aromatics (624/8260) • __ Coliform P/A (Public supplies) __ Coliform MPN ’(priv well, raw, stp) ,__ Volatile Aromatics (524) XI Acrolein & Acrylonitrile (8260) __ Total Trihalomethane Potential (510) _ Organochlo'rine Pesticides (608/8081)' .. Fecal Coliform (all samples) __ Microscopic, __ Microextractables (504) __ PCB’s (Arochlors) (608/8081) __ Pesticides/PCB screen (508) ' _ Herbicides (SM18/6630,8151) __ Macroscopic __ PCB as Decachlorobiphenyl (508A) ’7 _ Other Pesticides (SMI8/6630) _ API __ Other: ? ’ ‘ _ Herbicides (515) ' I' Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) ' ' __ Glycols in Water . Refrigerated? ,yes no _2 Carbamate Pesticides (531) _ Acid Extractables (625/8270) no " 212-Glyphosate (547) Base Neutral Extractables (625/8270) Chlorinated:? ^yes— _ Diquat (549) ‘ _i:GC/MS Unknown Scan < Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) I _■ Phthalates (606MS) ' Total Chlorine Res: . mg/L __ Haloa'cetic Acids (552) _ 'other: __________ b ______ __ Other Pesticides (SMI8/6630) pH ______ :______ _UCMR‘List1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) ■ .1

(___ Radon I L Other

I. INORGANIC ANALYSIS REQUESTED - Lab#: ■ > / . ‘ 1 > I ’’ r.' ,__ Color __ Turbidity ‘ __ Acidity __ Alkalinity Aluminum __ .’Antimony .) . Potassium __ Selenium __ pH __ Bromide __ Arsenic .• _ Silver) _ _L Conductivity __ Bromate'/Chlorate/Chlorite ^Barium * ; _ Sodium' _ Corrosivity (temp: °C) __ Chloride " Beryllium jj_. Thal Hum’ BOD (5 day) __ Cyanide Boron ‘ _yanadium _ Carbonaceous BOD (5 day)' __ .Fluoride’ , __ Cadmium t J- __ .-Zinc: ■ _ Soluble BOD (5 day) Hardness, Total as CaCOa __ Calcium, as CaCOa t CLP __ Chemical Oxygen Demand ‘__ ' Dissolved Oxygen t __ Nitrogen, Ammdnia as N ___ Nitrogen, Nitrate as"N __ Calcium, Ca*2' •_Chromium, Total , < f _ Metals/CN __ Nitrogen, Nitrite as N __ Volatiles. _ Total Organic Carbon __ Chromium, Hexavalent ■I 1_ Semi-violatiles __ Total Organic.Halides _ Nitrogen, Total Kjeldahl as N _ Cobalt • ■i '1 __ Pesticides/PCB’s _L Solids, Percent (%) __ ^Oil and Grease Copper ■ t _ Solids, Settleable r __ Phenol _^lron , 1 TCLP __ Solids, Suspended t Phosphorus Total as P ___Lead _TCLP-Metals __ Solids, Total __ 1 Phosphorus, Ortho as P ■):^"Magriesium F- _ Solids) Total Dissolved __ .. Sulfates _LxManganese J_ TCLP-Pesticides 1 __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants '. __.Mercury » I i _TCLP-Volatiles jy ■ JL Other; 2 _ UV254, Molybdenum I-. ’ 1 I _ TCLP-BNA’s -lii'Nickel 1 i {

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