Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document ■■ I

■■ L . . ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM> A’, WESTCHESTER COUNTY LABORATORIES AND RESEARCH t 2 Dana Road, Valhalla, New York 10595 ’ p? O/I I y ■■ ■ (914) 231-1620 Fax (914) 231-1772 , 1 4 ! t I NYS-ELAP No. 10108, A - Time/Date Set: ' ’I J Form A-70 (rev. 10/01)' I , ■ I-

,Samp[e_Type (circle one): Her ■ J <^5^. (l. Potable) ' 3. Non Potable Treated " ■ Bottle #’s: ' fA b ------ t 2. Non Potable ’ . 4. Other .Chain of Custody? Yes___ No I 4-’

‘Time/Date Collected: r A—. AV V-'-’-- , Comments:

Collected By: Agency Code: PWS #: Source ID: Type’ Descriptor:

r, Collected From:' I Bill to; I", Location’s/lndividual’s Name t Name/Company__ L • I,

Street_________ 4 Street -__________________ __ City/St/Zip_______ * City/St/Zip

I" iA *■ Identification of Source Collection Point " A . Phone#:_________ L

CA,CH, Bl? Check#: Fax#:

Amounts I I

BACTERIOLOGICAL ANALYSIS Lab#: “A' Lab#: ’ ' ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS ' __ Heterotrophic Plate Count ;■__ Trihalomethanes (524) Purgeable Halocarbons (624/8260) .'(hemodialysis & all others) __ Volatile Halocarbons (524) - __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) Acrolein &-Acrylonitrile (8260)

I __ Total Trihalomethane Potential J510j ,__ ' Organochlorine Pesticides (608/8081) __ Fecal Coliform (all samples) __ Micro'extractables (504) PCB’s (Arochlors) (608/8081) __ Microscopic Pesticides/PCB screen (508) _ Herbicides (SMi8/6630,8151) __ Macroscopic j - PCB as Decachlorobiphenyl (508A) ■ Other Pesticides (SMI8/6630) _ API __ Herbicides (515) ,*■___Petroleum Hydrocarbon Scan (310-13) __ Other: Pesticides (525) Gly'cols in Water . t ''' Ft Refrigerated?yes no, __ Carbamate Pesticides (531), Acid Extractables, (625/8270) _ Glyphosate (547) ''__ Base Neutral Extractables (625/8270) Chlorinated:? yes no .

I Free Chlorine Res: Total Chlorine Res: . mg/L jmg/L _ Diquat (549) __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) -__ GC/MS Unknown Scan .1_ Phthalates’(606MS) __ Other: » ’ _______________________

I- 5,.T pH '----------- -

RADIOCHEMICAL ANALYSIS 1 _Other Pesticides (SMI8/6630) ^UCMRListl’ _.MtBE Only (524) ■i

1 ’.I

t I

t ' T _Radon 1. Other i- 11

INORGANIC'ANALYSIS requested - Lab#: A / I, ■I

'__ Color __ Acidity j Aj Aluminum •V i" __ Turbidity. ’_’PH I __ Alkalinity __ Bromide » A Antimony A Arsenic ' i__ Potassium A Selenium Silver A __ Conductivity __ Bromate/Chlorate/Chlorite. A Barium • __ Sodium' '__ Corrosivity (temp:. °C) __ Chloride ‘ A Beryllium 'A. Thallium _ BOD (5 day) __ Cyanide •1 __ Boron. • ! __ Vanadium __ Carbonaceous BOD (5 day)’’ Fluoride __ Cadmium A Zinc !; ^ Soluble BOD. (5 day) __ Hardness, Total as CaCOs __ Calcium', as CaCOa __ Calcium, Ca*2 CLP __ ' Chemical Oxygen Demand ___ Nitrogen, Ammonia as N Metals/CN (__ Dissolved Oxygen _ 1 Nitrogen, Nitrate as N ^Chromium, -Total K? • _ Volatiles _ Total Organic Carbon ) __ ‘. Nitrogen, Nitrite as N __ Chromium, Hexavalent •, I __ Semi-violatiles S'’ __ Total Organic Halides (__ Solids, Percent (%) ' ___ Nitrogen, Total Kjeldahl as N __ Oil and Grease Cobalt Copper __ Pesticides/PCB's &■ '* __ Solids,'Settleable Phenol^ A Iron , ALead ’ TCLP __ Solids, Suspended __ Phosphorus Total as P‘ 1 _TCLP-Metals ■__ Solids, Total __ Phosphorus, Ortho as P ___Magnesium

£ I __ TCLP-Pesticides __ Solids, Total Dissolved ’ __ _ Sulfates A Manganese । I __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants A Mercury 1 c (■

_ TCLP-Volatiles jY Other: _ UV254 Molybdenum _2 TCLP-BNA’s i .A Nickel r NYC-WTC_OOo673577