Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document i

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER.COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 o/ ■ & 1 1 ‘(914) 231'-1620 Fax (914) 231-1772 * / -7 -

■ 7;? NYS-ELAP N0.MOIO8 , Time/Date Set:/. I Fo'rm A-76 (rev.10/01)

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Sample .Type (circle one): " O. Vz 7 t - 1

1. Potable 3. Non Potable treated ■ Bottle #’s: ‘ V ■ . 2. Non Potable 4‘. Other■I , " Chain of Custody? ^2 ’Yes No

Time/Date Collected: Comments: S1 Collected By: .7 ■ ACr •>’..! (£> Aaencv Code; PWS #; _____ ' Source ID; .Type Descriptor:

Collected From: r Bill to: I i 'Location's/lndividual’s Name Name/Company

W' i Street ^■■ Street_________ V- ■( 'City/St/Zip______ J!________ ;i_ City/St/Zip i Identification of Source Phone#: Fax#: i ^Collection Point_____________ L I ■» CA,CH, Bl?‘. . Check#: Amount$r. I J . .. ■ V J _ L BACTERIOLOGICAL ANALYSIS Lab#:

I Lab#: _!__12______________ ■ i. Heterotrophic’Plate Count r, i(hemodialysis‘& alfotbers) >■7- __iColiform P/A (Public supplies) ’ ORGANIC POTABLE ANALYSIS _Trihalomethanes (524) __ Volatile Halocarbons (524) 1 ORGANIC 'nONPOTABLE/SOLID ANALYSIS . ' Purgeable Halocarbons (624/8260): _ 'Purgeable Aromatics (624/8260) ■i

__ 'Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) r :1 __ Total Trihalomethane Potential (510) _ Organochlorine Pesticides (608/8081) _ Fecal Coliform (all samples) _:.’Microextractables'(504) _, PCB’s (Arochlors),(608/8081); ■' '■ Microscopic Macroscopic ' __ Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,8151) '' __ PCB as Decachlorobiphenyl (508A) - . __ Other Pesticides (SM18/6630) 1 J_ API ‘ , I _ Herbicides (515) Petroleum Hydrocarbon Scan- (310-13) _ Other:______ _ I 1__ Pesticides (525) . ■__ ■ Glycols in Water . ' 1 Refrigerated? yes___ no Carbamate Pesticides (531) _ Acid Extractables (625/8270) \__ Glyphosate (547). __ Base Neutral Extractables (625/8270) Chlorinated;? yes no, i_ .Diquat (549) ■__ GC/MS Unknown Scan ’• Free Chlorine Res:. mq/L- J_ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) ‘ iJ Total Chlorine Res: ________ mg/L ) Haloacetic Acids'* (552) ■' __ Other;____________j_____________ (: _LOther Pesticides (SMI8/6630) _LUCMRList1 ' ' ' • RADIOCHEMICAL ANALYSIS _i MtBE Only (524) ' * ___ Radon S' pi ’7 ' ‘Other. 1 .. / '/ / ■'

K- ' INORGANIC ANALYSIS REQUESTED Lab#: / '‘''Aluminum __ Potassium,. ' Color ‘ ” __ Acidity ___ Turbidity j __ Alkalinity ^.Antimony ' ■/ Seleniurh ^_.pH I ■ __ Bromide jA Arsenic ■ Silver

r. - ' “Conductivity . (__ Corrosivity ‘ (ternp./°C) °C) _ Bro'mate/Chlorate/Chlorite __ Chloride V Barium _£'Beryllium ___Sodium .Thalliurn

1/ ' BOD (5 day) _ Carbonaceous-BOD (5 day) ,_:S6luble BOD (5day)' ’ ' ‘ Cyanide _ _ Fluoride __ Boron __ Cadmium __ Vanadium J ^XZinc, __ Hardness, Total as CaCOa __ Calcium, as CaCOs I- B’ __ '■ Chemical Oxygen Demand ’__ Dissolved Oxygen __ Nitrogen, Ammonia as N __ Nitrogen, Nitrate as N __ Calcium, Ca*2 ^tlChromium, Total CLP _ Metals/CN __ Volatiles ‘

I" __ Total Organic Carbon __ J Total Organic Halides Solids, Percent (%) ’ ,___Nitrogen, Nitrite as N ___ Nitrogen, Total Kjeldahl as N __ Oil ancl Grease __ Chromium, Hexavalent /- Cobalt ■/ Coppe'r . Semi;violatiles __ Pesticides/PCB's .~__ Solids, Settleable. , _ Phenol ■/' Iron TCLP _ Solids, Suspended’' __ Phosptiorus Total as P ^Lead _TCLP-Mefals __ Solids, TqtaP * __ Phosphorus, Ortho as P . ___Magnesium ___TCLP-Pesticides __ Solids, Total Dissolved , __ Sulfates V'" Manganese __ TCLP-Herbicides''- :__ ,, Solids, Total Volatile ___ Surfactants ■/'Mercury ;__ TCLP-Volatiles V, Other: • V , UV254 \ ./Molybdenum ■_ TCLP-BNA's' ■ I Nickel.

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