Chain of Custody Record, Sample AE03730, Feb 2002

NYC 9/11 Public Portal Document

»«• ACCn ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 . t i (914) 231-1620 Fax (914) 231-1772 . L '•'-NYS-ELAP No. 10108 i Time/Date Set: Form A-70 (rev. 10/01) f'

I Sample Type (circle one): J 1. Potable 3. Non Potable Treated Bottle #’s: / '2. Afl 2. Non Potable 4. Other Chain of Custody?___ Yes No I 6s Time/Date Collected: 2.. V- Comments: J Collected By: _J_L_ 2 Agency Code: PWS #:_______ Source ID: Type Descriptor: I Collected From: Bill to: I ■/ A Location’s/lndividual’s Name Name/Company I Street____________________ Street_________ City/St/Zip________________ City/St/Zip I Identification of Source Phone#: Fax#: 7 S A’ Collection Point CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#: I Lab#:_______________________ , ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS ' __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260), (hemodialysis & all others) '■1 __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) ! i __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Acrolein & Acrylonitrile (8260) __ Organochlorine Pesticides (608/8081).. •J __ Fecal Coliform (all samples) __ Microscopic __ Microextractabies (504) _ PCB’s (Arochlors) (608/8081) 7 __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) I __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI8/6630) f _ API __ Herbicides (515) __ Petroleum Hydrocarbon Scan (31O-'13) __ Other:; I __ Pesticides (525) __ Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) __ Acid Extractables (625/8270) ■i ■pi I __ Base Neutral Extractables (625/8270) ' ' Chlorinated:? yes no __ Glyphosate (547) t __ Diquat (549) 2^GC/MS Unknown Scan Free Chlorine Res: . mg/L 7* __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) I Total Chlorine Res: . mg/L __ Haloacetic Acids (552) Other:- pH _ ___________

RADIOCHEMICAL ANALYSIS ___Other Pesticides (SMI8/6630) _UCMRList 1 _ MtBE Only (524) /I ___ Radon i ■

I __ Other_______________________ Yi ■

i INORGANIC ANALYSIS REQUESTED - Lab#: ) 1 __ Color __ Acidity __ Aluminum __ Potassium J ■I' __ Turbidity __ Alkalinity ^'Antimony ""Selenium _ pH __ Bromide 2:l_Arsenic 12.'Silver I __ Conductivity __ Bromate/Chlorate/Chlorite Barium -""Sodium __ Corrosivity (temp:. .°C) __ Chloride _k.''Beryllium Ai'Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium I __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium -Zinc- ! __ Soluble BOD (5 day) __ Chemical Oxygen Demand __ Hardness, Total as CaCOs __ Nitrogen, Ammonia as N __ Calcium, as CaCOs __ Calcium, Ca-^2 CLP __ Metals/CN fl I __ Dissolved Oxygen __ Nitrogen, Nitrate as N ^"Chromium. Total I __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N Cobalt __ Pesticides/PCB’s I __ 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 k __ TCLP-Pesticides ; r __ Solids, Total Dissolved __ Sulfates _>''Manganese _TCLP-Herbicides' __ Solids, Total Volatile __ Surfactants _1 Mercury _ TCLP-Volatiles IrfOther: ____________ _ UV254 Molybdenum _ TCLP-BNA’s Nickel St

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