Chain of Custody Record, Sample AE03388, 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 1 wLSMH&ialtSMLJ X (914)231-1620 Fax (914) 231-1772 ! 1 NYS-ELAP No. 10108 i Time/Date Set: Form A-70 (rev.10/01) I / Sb'/ Sample Type (circle one): r ne:. / M.potable ? 3. Non Potable Treated Bottle #'s::__________ Z^Non Potable 4. Other __ _________ Chain of Custody? j__ Yes___ No Tinie/Date Collected: ? /n /AZ Comments: Collected By; < ■ .■ .t' - Agency Code; PWS#:____ __ Source ID: Type Descriptor: . Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street Street________ J City/St/Zip Ua * Zw //6 City/St/Zip Identification of Source Phone#: Fax#:. i Collection Point CA,CH, Bl? Check#: Amounts. !

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS/ ORGANIC NONPOTABLE/SOLID ANALYSIS J ,__ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) 1 _CA76latile Halocarbons (524) __ Purgeable Aromatics (624/8260) ‘ __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) LAZbIatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) ! __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) __ Microscopic __ 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) i __ Pesticides (525) __ Glycols in Water Refrigerated?yes___ no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) i __ Glyphosate (547) _ Base Neutral Extractablesf (625/8270) Chlorinated:? yes no _ Diquat (549) __!r'GC/MS Unknown,Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (666MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other:________________ ;___________ 1 _ Other Pesticides (SMI 8/6630) 1 pH ___________ _UCMRList1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon ___ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ jflcidity Z^TXIuminum __ Potass! J __ Turbidity __ Alkalinity ‘--'Antimony j-rSeleniu _ pH __ Bromide u-Arsenic i±rSilyer C • .. __ Conductivity __ Bromate/Chlorate/Chlorite ji'Barium Sodium I __ Corrosivity (temp:. .°C) __ Chloride _ir6eryllium _^Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride i^admium i.-Zinc i _ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs CLP J r __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca« _.Metale/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N _i<Chromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent r t __ Total Organic Halides _ Solids, Percent (%) __ Nitrogen, Total Kjeldahl as N __ Oil and Grease ^■Cobalt .'■-Copper __ Semi-violatiles __ Pesticides/PCB’s

i __ Solids, Settleable __ Solids, Suspended __ Solids, Total __ Phenol __ Phosphorus Total as P __ Phosphorus, Ortho as P 6.-4 ron _iJread __ Magnesium TCUP _TCLP-Metals i __ Solids, Total Dissolved __ Sulfates .ij^dtlanganese __ TCLP-Pesticides __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants _jcrMercury _ TCLP-Volatiles .i^ZOther: ________ _ UV254 . -^Molybdenum _ TCLP-BNA’s _Miiickel

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