Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

ft' ' : ' ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER.COUNTY LABORATORIES AND RESEARCH ■ 2 Dana Road, Valhalla, New York 10595 ‘‘ /' ■ I— a 1< - (914) 231-1620 Fax (914) 231-1772 ■ 1*1 I !’ ' NYS-ELAP (Mo. 10108 “ Time/Date Set; Form A-70 (rev. 10/01)

£ Sample Type* (circle one): (^JPotabl^/f , 3. Non Potable Treated -v

’ Bottle #’s: .;.Y' AY", ft . - ) I 2. Noh Potable '4. Other - - T Chain of Custody? Yes No - ' L. if Time/Date Ci^lected: Comments::______________ t.

Collected. By: Agency Code: PWS #:_______ Source ID: type 'Descriptor:

Collected From: , Bill to: (- . '.I S'. I Location’s/lndividual's Name Name/Company &■

Street_______ ____________ Street * 1. -City/St/Zip _______ Citv/St/Zip £ ' 1 11 fc- s'.- ' Identification of Source _j___ Phone#: Fax#:

fr Collection Point

BACTERIOLOGICAL ANALYSIS' Lab#: — - I CA CH, Bl? Check#: ' «. 'Amounts * t

ft Lab#: _'‘Heterotrophic Plate Count (hemodialysis & all others) ORGANIC POTABLE ANALYSIS “ __ Trihalomethanes (524) ftft Volatile Halocarbons (524) , ' ORGANIC NONPOTABLE/SOLID ANALYSIS ' ,._>l_''.Purgeable Halocarbons, (624/8260) '__ Purgeable Aromatics' (624/8260) __L' Coliform P/A (Public supplies) __ Coliform MPN. (priv well, raw, stp) __ Volatile Aromatics (524) , '- ‘ , __ Acrolein & Acrylonitrile, (8260) j YL Fecal Coliform' (all samples) Total Trihalomethane Potential (510) , __ Organochlorine Pesticides (608/8081) ' __ Microscopic *■ , ,__ Microextractables (504) , _ PCB’s (Arochlors) (608/8081) __ Macroscopic ,i __ Pesticides/PCB screen (508) Herbicides (SM18/6630,8151) 1

fe __ API ■ _L Other:_ ______________________

Refrig'erated?yes ___ no’- _ PCB as Decachlorobiphenyl (508A) __ Herbicides (515) iL Pesticides (525) ___ Carbamate'Pesticides' (531) ' _ Other Pesticides (SMI8/6630) __ Petroleum Hydrocarbon Scan (310-13) _2 i Glycols in Watert Acid Extractable's (625/8270) £' Chlorinated:? yes___ no __ .Glyphosate (547) < . __ Base Neutral Extractables' (625/8270) ___ GC/MS Unknown Scan * « __ Diquat (549) Free Chlorine Res:ftmg/L ;__ Chlorination Disinfection.Bypfoducts (551) ' ■» -it Phthalates (606MS) _ f

fe' Total Chlorine Res: mg/L, pH-_____________ __ Haloacetic Acids (552) __ Other Pesticides (SMI8/6630) . ;_LUGMRList1 , - Other:_______________ 2_L 1 f RADIOCHEMICAL ANALYSIS _MtBE Only (524) i S'

r __ .Radon ‘ \ f ;__ Other__________ ______________ ------------------ ------------------------------------------------------- i INORGANIC ANALYSIS REQUESTED, - Lab#:ft J' .■V-- I '' i ___ Color - . __ Acidity, ' Y. Aluminum -__ 'Potassium K’,.- ,__ Turbidity __ Alkalinity Ji V' Antimony _Y Selenium *■ > i J.’, pH ' Bromide 'Ai Arsenic / Silver; r, '2_ Conductivity __ Corrosivity (temp:. °cj __ Bromate/Chlorate/Chlorite.,. __ Chloride jY Barium .jif’Berylliurh __ Sodium Thallium BOD (5 day) ,__ Cyanide t _ Boron / __ ^.Vanadium . r _ Carbonaceous BOD (5 day) ,__ Fluoride __ Cadmium vS Zinc I t _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOa ’ CLP • ; __ Chemical Oxygen Demand __ Nitrogen/Ammonia, as N L_ Calcium, Ca^J _Metals/CN ’ ____ Dissolved Oxygen -' '__ Nitrogen,-Nitrate as N y/Chromium, Total . Volatiles ' ’ __ Total Organic Carbon Nitrogen, Nitrite as N __ -Chromium, Hexavalent . . _,Nitrogen, Total Kjeldahl as N? ■J_ Semi-violatiles __ Total Organic Halides YI Cobalt ‘ -__ 'Pesticides/PCB’s __ Solids, Percent (%) _ Oil and Grease -Zl Copper __ Solids, Settleable __ Pheriol — Iron TCLP * ' ‘ __ Solids, Suspended ■ \ c Phosphorus Total as P 'Y. Lead ''_TCLP-Metals^ __ Solids’, Total _ Phosphorus, Ortho as P _l^Magnesium ■ ’ - ^''Manganese ' ' _TCLP-Pesticides ■■ ■ Solids, Total Dissolved __ Sulfates '^tCLP-Herbicides __ Solids, Total Volatile __ Surfactants / Mercury _ TCL P-Volatiles Other: _ UV254 Yi-.Molybdenum TCLP-BNAs, \ A Nickel, .

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NYC-WTC_000073600