Chain of Custody Record, Sample AE03798, Feb 2002

NYC 9/11 Public Portal Document

environmental services sample submission form •? ■■ <cr WESTCHESTER COUNTY LABORATORIES AND RESEARCH »» >> "-y I■ a 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 ■ Time/Date Set? NYS,-ELAP No. 10108 FoffnA-70 (rev. 10/01) ■ Sample Type {circle one)? 1. Potable 3. Non Potable Treated Bottle #’s;_ ____ L 9 2. Non Potable -4. Other: ;: Chain of Custody?; Yes No ............ Cominents' IIHI Time/Date Collected:; Collected By:f 7y Agency Code: /c/ , .. / pvyq Source ID:Type Descriptorj ■I Collected From; Bill to: Location’s/lndividuai’s Name _ Name/Company Street: Street, II City/St/Zip. City/St/Zip______ ; Identification of Source______ : Phone#:________ : Fax#? Collection Point____________ j 7-: , CA,CH, Bi? Check#? Amounts) IB

3AC reRIOLOGICAL ANALYSIS Lab#:____________________ _ ____ ) Lab#? 1It ORGANIC POTABLE ANALYSIS ' ORGANIC NOMPOTABI..E/SOLID ANALYSIS __ Heterotrophic Plate Count * __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeabie Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Total Trihalomethane Potential (510) __ Fecal Coliform (all samples) __ Microscopic ___ Microextractables (504) __ Organochlorine Pesticides (608/8081) __ PCBs (Arochlors) (608/8081) 3 __ Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630.8151) :3 __ API __ Other;________________________ : __ PCB as Decachlorobiphenyl (508A) __ Herbicides (515) Other Pesticides (SMI8/6630) __ Petroleum Hydrocarbon Scan (310-13) 1 __ Pesticides (525) __ Glycols in Water ■ Refrigerated?yes Chlorinated:? yes no no __ Carbamate Pesticides (531) __ Glyphosate (547) „ Acid Extractables (625/8270) _ Base Neutral Extractables (625/8270) ■ Free Chlorine Res:: Total Chlorine Res; - mg/L . mg/L: __ Diquat (549) __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) ■ --GC/MS Unknown Scan _ Phthalates (606MS) __ Other:___________________________ ___ ■ IB pH _____________ _ Other Pesticides (SM18/6630) S RADIOCHEMICAL ANALYSIS _UCMRList1 __ MtBE Only (524) a ___Radon __ Other_____________________ __ s■t ANORGANIC ANALYSIS REQUESIED - __ Color __ Acidity __ Aluminum __ Potassium I Turbidity __ Alkalinity __ Antimony __ Selenium pH __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium __ Sodium Bj: __ 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 CaCOs __ , K __ Chemical Oxygen Demand __ Dissolved Oxygen __ Total Organic Carbon __ Nitrogen, Ammonia as N __ Nitrogen, Nitrate as N __ Nitrogen, Nitrite as N __ Calcium, Ca*2 __ Chromium, Total __ Chromium, Hexavalent: _ Metals/CN Volatiles ■ __ 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 _TCLP-Metals __ Solids. Total Phosphorus, Ortho as P ___ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates __ Manganese „„TCLP-Herbicides ■ __ Solids, Total Volatile » __ Other:_____________________ Siirfactants _ UV254 __ Mercury __ Molybdenum _ TCLP-Volatiles __ TCLP-BNA’s ■■ __ Nickel Mi W NYC-WTC_000073826