Chain of Custody Record, Sample AE03798, Feb 2002

NYC 9/11 Public Portal Document

■■IO ENVIRONMENTAL. SERVICES SAMPLE SUBMISSION FORM '8 ■?.,

>ler f Ta\.C( JUT WESTCHESTER COUNTY LABORATORIES AND RESEARCH * SI 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914)231-1772 1115^ IB ' NYS-ELAP No. 10108 Time/Date Set: !■< ■■?■ ■-/,C,ZJ/ ■ Form A-70 (,-07.10/01) Sample Type (circle one). /• ■■ ■ G' ■otabY

2. Non Potable 3. Ncn Potable Tr3ated

4. Other Bottle #'s: Ct S7Y- k' G Chain of Custody?Yes___ No / M-Y g / /q__ I 'Y 8 Time/Date Collected: ■ K 2 O; Comments;. Collected By; L. v'LOTjAgf Agency Code: _ PWS #:_______ Source ID;i .Type Descriptor: Collected From Bill io; I LcH-.i;ion’c/lndivi.-iunl's Name ... .Ll'J.C' 11^ ... ■ Name/Company Street:__ __________________________________ ; City/St/Zip__ ■ Y________________________ XUSiSj Street_________ I City/SVZip I identification of Source_______ _______________________ _ Coitection Point LL-Z -Z. ft________ Phone#:

CA.CH, Bi? Check#:: _ Fax#: :

Amounts; I BACTERIOLOGICAL ANALYSIS Lab#:; Lab#: I ORGANIC PO1A3LE ANALYSIS ORGANIC NONPOTABLE-SOLID ANALYSIS __ Heterotrophic Plate Count __ Tfihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & ail others) j^YVolatile Halocarbons (524) .. . Purgeable Aromatics (624/8260) ■ __ Coliform P/A (Public supplies) _jtf4^latile Aromatics (524) Acrolein & Acrylonitrile (8260) __ Coliform MPN (priv weii, raw. stp) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) PCB's (Arochlors) (608/8081) Macroscopic __ Pesticides/PCB screen (508) Herbicides (SM18/6630,8151) API __ PCB as Decachlorobiphenyl (508A) ...... Other Pesticides (SM18/6630) Other;____________________ _ __ Herbicides (515) ..... Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) Refrigerated?yes no __ Carbamate Pesticides (531) __ Glycols in Water Acid Extractables (625/8270) ■ Chlorinated:? yes no __ Glyphosate (547) __ .^ase Neutral Extractables (625/8270) __ Diquat (549) jZGC/MS Unknown Scan Free Chlorine Res:; . mg/L __ Chlorination Disinfection Byproducts (551) ■I _ Phthalates (606MS) Total Chlorine Res:, . mg/L: __ Haioacetic Acids (552) __ Other:_______________________________ _ Other Pesticides (SM18/6630) pH _____________

RADIOCHEMICAL. ANALYSIS UCMR List 1 Only (524) I ___Radon

■=----- __ Other_______________________ _ Bi INORGANIC ANALYSIS REQUESTED - tab#: z .H js^^uminum Illi _ Color Turbidity __ /^idity __ Alkalinity _Lx^timony ■rsenic __ .Potassium J^elenium i pH __ Bromide .rfSilver __ Conductivity __ Bromate/Chlorate/Chiorite .■ferium __^dium __ Corrosivity (temp; .“C) __ Chloride j-^Beryllium Thallium IB __ BOD (5 day) __ Cyanide __ Boron _ >!nadium _ Carbonaceous BOD (5 day) Fluoride .^.Xladmium Zinc Soluble BOD (5 day) __ Hardness. Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand Nitrogen, Ammonia as N __ ^Icium, Ca*2 •__ Dissolved Oxygen _ Metals/CN __ Nitrogen, Nitrate as N jZChromium, Total __ Voijit/es __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent: _ii^obalt __ Semi-violatiles Total Organic Halides __ Nitrogen, Total Kjeldahl as N: -iZ^oPper _ Pesticides/PCB's __ Solids, Percent {%) __ Oil and Grease __ Solids, Settleabie __ Phenol _s^on ICLP __ Solids, Suspended Phosphorus Total as P ■Lead „__TCLP-Metais __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium _ TCLP-Pesticides __ Solids, Total Dissolved Sulfates _j^tonganese ^.■ercury __.„TCLP-Herbicides Solids, Total Volatile __ Surfactants _i;<^ther: ' . 5 : __ TCLP-Volatiles „ UV254 _±rWiybdenum _ TCLP-BNAs ..■iickel

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