Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document s- ...................... ! ' ■

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 1 2 Dana Road, Valhalla, New York 10595, I' 1 o/ ■ ® 1 .X J (914) 231-1620 Fax (914) 231-1772 1 ’ NYS-ELAP No. 10'108 r Time/Date Set: J Form A-70 (rev. 10/01) -------- --- ■ Sarnple .Type (circle one); 1 Cl; Potabld _ 3. Noh Potable Treated , ’ Bottle,tfs:

2."Non Potable 4. Other J___________ !_j. . - / Chain of Custody?,.^Yes. No .,, Ch itT Comments: “I / ■> ■ ‘Time/Date Collected:* _ 7..- Collected Bv: > 7. iAt'-. ’ '/ Agency Code; PWS #; ' Source ID; Type Descriptor;

r Cdllected From: Location's/lndividual's Name -*•

Street____________________ __ -A’’'' 1 I Bill to: Name/Company Street <'• 1'

I

I- " ' 'City/St/Zip^_______ City/St/Zip Identification of Source Phone#; Fax#: f F Collection Point CA,CH, Bl? '‘I- Check#: Amounts 1

B'.' BACTERIOLOGICAL ANALYSIS Lab#: . .Lab#:

ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS , __L Heterotrophic Plate Count j ■' L_ Purgeable' Halocarbons. (624/8260) __ Trihalomethanes (524) I (hemodialysis & all others) __ Volatile Halocarbons (524) 2_' Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) * v ___ Acrolein & Acrylonitrile (8260) /__ Fecal Coliform (all samples) __ .Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) ‘__ Microextrac'tabies (504) ‘ r PCB’s (Arochlors) . (608/8081) _ Microscopic

I’ __: Macroscopic ._"API ■_L Other: I i__ Pesticides/PCB screen (508) > • __ PCB as Decachlorobiphenyl (508A) • _ Herbicides (515) : Herbicides (SMI8/6630,8151) .• other Pesticides (SM18/6630) • _ Petroleum Hydrocarbon Scan (310-13) __ . Pesticides (525) ’ * _ Glycols in Water . , Refrigerated? yes __no __ .'Carbamate Pesticides (531) *_ Acid Extractables (625^270)

k Chlorinated:? 2. yes no __ Glyphosate(547) j __ Base Neutral Extractables (625/8270) IP __ Diquat (549) GC/MS Unknown Sc^> Free Chlorine Res: - mg/L ■__ Chlorination Disinfection Byproducts (551) Phthalates (ebe'MSf Total Chlorine Res:'* -mg/L __ Haloacetic Acids (552) _ Other:____________ , __________ _ Other Pesticides (SM18/6630) •1 I

It" : ph_2—'

’ , RADIOCHEMICAL ANALYSIS _UCMRList1 _MtBE Only (524) ^Radon I

b.: _ Other. I

. L 1. INORGANIC ANALYSIS REQUESTED - Lab#: " ) ; 1’ • __ .Color __ Acidity /__ Alurriinum Potassium Si:,' r J Turbidity __ Alkalinity /__ Antimony.. _ Selenium ■ .-.pH __ Bromide ' ’__ Arsenic _ Silver ..

I-. __ Conductivity Corrosivity (temp; ' ' BOD (5 day) °C) J __ _ Bromate/Chlorate/Chlorite __ Chloride, __ . Cyanide ‘ __ Barium , _ Beryllium __ Boron » ‘'I __ Sodium __ Thallium • Vanadium

I. ' Carbonaceous BOD (5 day) ’__ Soluble BOD (5 day) __ ..Fluoride _ Hardness, Total as CaCOs J __ Cadmium. _ Calcium, as CaCOa | ■4..

r __ Zinc CLP _ Cheitiical Oxygen Demand __ Nitrogen, Ammonia as^N ___ Calciurh, Ca*^ ' J '__ Dissolved Oxygen ' ' ___ Nitrogen, Nitrate as N __ Chromium, Total , I _2Metals/CN ^-2 ,_t Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N ' __ Chromium, Hexavalent ’_ : Total Organic Halides i _ Nitrogen, Total Kjeldahl as N' _Cobalt __ Semi-violatiles 1 J i; Solids, Percent (%) __ Pesticides/PCB’s i ___ Oil and Grease . ' __ Copper I''?' _ Solids, Settleable _ phenol __ Iron I 4

TCLP ‘ I,

■__ Solids, Suspended __ Phosphorus Total as P, ._Lead ' Solids, Total __ TCLP-Metals __ ‘Phosphorus, Ortho as P •. __ Magnesium '! ;_ Solids, Total Dissolved 1__ TCLP-Pesticides _ Sulfates - __ Manganese I" Solids, Total Volatile Other: ' ‘ . _ Surfactants ‘ __ Mercury ’ f* __ TCLP-Herbicides _ TCl_P-Volatiles . _ UV254 * __ Molybdenum i _ TCLP-BNA's __ Nickel ! I !■

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