Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

■ ■: ' ' ,. .. ' ft ft ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ^^gpvcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH . „l. liZ-i?' ' ■ - > , 2 Dana Road, Valhalla, New York 10595 ■ (914)231-1620 Fax (914) 231-1772 ' (ft - ft / sneHOr NYS-ELAP No. 10108 ... Y ( Time/Date Set: Form A-70 (rev. 10/01)' J -I ,1- ■ ."J 4 ■>* -

Sample Type (circle one): 1. Potable 3.;Non Potable Treated Bottle #’s: -- / ft A t "i it '-J .2. Non Potable 4. Other Chain of Custody? Yes': No . Time/Date Collected: Comments: ■* '

Collected By: Aaencv Code: PWS #: __ _____ 2__ Source ID:. 2 Type Descriptor: I •■Collected From: Bill to: f Location’s/lndividual’s Name Name/Company i Street -• Street_____

'fe City/'SVZip______ _______ Identification o'f Source City/SVZip Phone#:- ■i

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Fax#: i'T I /Collection Point aS* S/' I CA.CH. Bl? Check#:i 2 Amounts If-' BACTERIOLOGICAL ANALYSIS Lab#:

ft* Lab#:'__________________ _ ORGANIC POTABLE ANALYSIS 1 ,i ORGANIC NONPOTABLE/SOLID ANALYSIS Heterotrophic Plate Count , __ Trihalomethanes (524) • • (hemodialysis & all others) __ Purgeable Halocarbons (624/8260) » lLI Coliform P/A (Public supplies)'* , __ Volatile Halocarbons'(524) ' Purgeable Aromatics (624/8260) Coliform MPN (priv well, raw, stp) _ Volatile Aromatics (524) * Acrolein & Acrylonitrile (8260) )' i__-Fecal Coliform (a"ll samples) ‘ __ Total Trihalomethane Potential (510) j_ Organochlorine Pesticides (608/8081) Microscopic '' _ _ Microextractables (504) 1_ PCB’s (Arochlors) (608/8081) ■_£ Macroscopic, _ I'Pesticides/PCB screen (508) Herbicides (SMI8/6630,8151) , , API .>__ PCB as" Decachlorobiphenyl (508A) Other Pesticides (SMI8/6630) _L Other:. __ Herbicides (515) .' ■ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) j_ Glycols in Water SY-' Refrigerated?yes -_ no^ _ Carbamate Pesticides (531) J_ Acid Extractables (625/8270) V, Chlorinated:? yes__ 1 no __ Glyphosate ■(547) " '__ Diquat (549) __ Basis Neutral Extractables (625/8270) _ _____ GC/MS____________ Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) Phthalates (606MS) Total Chlorine Res: mg/L __ Haloacetic Acids (552) ■" __ Other: ft" fiA- pH ___ _______ L I Other Pesticides (SM18/6630) lx I' _UCMRList 1 1. RADIOCHEMICAL ANALYSIS __ MtBE Only (524) 1 ' ___ .Radon ■ j, ! __ Other 1.1 Si .i INORGANIC ANALYSIS REQUESTED - Lab#: j - ftft Color __ Acidity ' Aluminum f. __ Potassium- 'Turbidity ’ __ Alkalinity ■' . Antimony J’ .^'Selenium pH ‘ .! |/ 1 ___Bromide , Arsenic - ,, | Y Silver ;__ Conductivity. ' ' ‘ Bromate/Chlorate/Chlorite j^Bahum . I. 2_ Sodium- __ Corrosivity Hemp: - °C) __ Chloride Beryllium r ,' „ ; ft/ Thallium Sft- ■_ BOD (5day) __ Cyanide - A _ Boron { ’ ( __ Vanadium __ Carbonaceous BOD (5 day) _ Fluoride j ■_LCadmium Zinc _ Soluble BOD (5 day) ■ __ Hardness, Total as CaCOs __ Calcium, as CaCOa 'ITlF' ■■■ ' - Chemical Oxygen Demand __ Nitrogen, Ammonia'as N __ Calcium, Ca+2 J '2_ Dissolved Oxygen ^Nitrogen, Nitrate as N 2^Chromium, TotalL _ Metals/CN __ Total Organic Carbon Nitrogen, Nitrite as N __ Volatiles __ Chromium’, Hexavalent Total Organic Halides __ 'Nitrogen, Total Kjeldahl as N ^/Cobalt ’ ‘ j_.Semi-violatiles ■' _L Solids, Percent (%) __ Oil and Grease _ Pesticides/PCB’s vYCopper . 1,_ Solids, Settleable' t __ Phenol . Y Iron ft. Sa -_ Solids, Suspended' Solids, Total , __ -Phosphorus Total as P __ Pho'sphbrus, Ortho as P _rl'Lead' Magnesium,. ■: J TCLP 2j_TCLP-Metals __ Solids, Total Dissolved i^ ' ft_TCLP-Pesticides __ Sulfates'. . Manganese _TCLP-Herbicides '' ‘__ Solids, Total Volatile __ Surfactants- Mercury x/ Other: ' _ UV254 _ TCLP-Voiatiles xY; Molybdenum' (r jY Nickel * ' . _,TCLPBNA’s . A ‘ ‘ 1

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