Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914)231-1772 I 5 NYS-ELAP No, 10108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type (circle one)? 1. Potable 3. Non Potable Treated Bottle #'s: &2 2. Non Potable 4. Other :_ Chain of Custody? Yes No Time/Date Collected: _ '/WvT Comments • ft-

Collected By;tff M Agency Code: 7-1 f' PWS #:: Source ID: Type Descriptor:^ IB Colicctod Froin: Bill io; ■ ■ H;i ' Location's/lndividual’s Name Nanie/Cornpany Street: Street■ IB City/St/Zip________________ City/St/Zip: identification of Source Phone#:: Fax#: ■ iSSS/

Collection Point CA.CH, Bl?: Check#: _ Amounts

bacteriological ANALYSIS Lab#:___________________________: Lab#:: •z Y ■■ ■1:

ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE; SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeabie Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) 1 __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) __ Volatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Acrolein & Acrylonitrile (8260) __ Organochiorine Pesticides (608/8081) ■SB __ Microscopic __ Microextractables (504) _ PCB's (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) . ... Herbicides (SM18/6630,8151) __ PCB as Decachlorobiphenyl {508A) _ Other Pesticides (SM18/6630) _ API __ Other;_________________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13): __ Pesticides (525) __ Glycols in Water Refrigerated?yes ___ no __ Carbamate Pesticides (531) Acid Extractables (625/8270) Chlorinated:?yes___ no __ Glyphosate (547) Base Neutral Extractables (625/8270) _ Diquat (549) Jl GC/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) Phthalates (606MS) Total Chlorine Res:mg/L! __ Haloacetic Acids (552) Other:: _ Other Pesticides (SM18/6630) pH _____________

RAOtOCHEMICAl. ANALYSIS _UCMRList1 _MtBE Only (524) ■■1^ _Radon _ Other!

INORGANIC ANAL.YS!S RrQUESTED - l. ilF : IlilllllBIIM __ Color __ Acidity _ Aluminum __ Potass! ium __ Turbidity __ Alkalinity __ Antimony __ Seleniui __ pH __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorale/Chlorite __ Barium __ Sodium Corrosivity (temp:’C) __ Chloride _ Beryllium _ Thallium BOD (5 day) __ Cyanide __ Boron __ Vanadium _ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium __ Zinc Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCO.) __ Chemical Oxygen Demand Nitrogen, Ammonia as N __ Calcium, Ca*2 _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles _ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles Total Organic Halides __ Nitrogen, Total Kjeldahl as N Cobalt __ Pesticides/PCB's: Solids, Percent (%) __ Oil and Grease __ Copper __ Solids, Settleable __ Phenol __ Iron TCLP __ Solids, Suspended Phosphorus Total as P __ Lead .___TCLP-Metals __ Solids, Total Phosphorus, Ortho as P __ Magnesium _ TCLP-Pestiddes _ Solids, Total Dissolved __ Sulfates __ Manganese __ Solids, Total Volatile __ Other:_________ _ __________ __ Surfactants __ UV254 __ Mercury __ Molybdenum __ TCLP-Herbicides „ TCLP-Volatiles __ TCLP-BNAs ■ __ Nickel ■ H II NYC-WTC_000073621