Chain of Custody Record, Sample AE03802, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ,-... ' ' WFSTCHFSTFR COUNTY laboratories AND RFSFARCH • '? fH. \A'( >f)i 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 ZNYS-ELAP No. 10108 Time/Date Set: zi- Form A-70 (rev. 10/01)

Sample Type (circle one):: 1 .Potable 3. Non Potable Treated Bottle #’s: iHJI IB ■I ■ I s 2. Non Potable 4. Other____________ ■■■■■ Chain of Custody? Yes No: s Time/Date Collected: Collected By: J, ■S

Agency Code: Connncnts: : Source ID:: _______________ ..Type Descriptor; a Cuilccted From: Bill to: Location's/lndividual's Name~ ‘ ~/L I Name/Company Street City/St/Zip- Street; I■ Identification of Source Phone#:: Fax#: Collection Point_______ )__ _1__ ' ' CA,CH, Bl?: Check#:- Amounts____ : i bACTERiOLOGICAL ANALYSIS Lab#:: ■ Lab#:_____ y____________________ j ___ Heterotrophic Plate Count (hemodialysis & ail others) ORGANIC POTABLE ANAIYSIS _^Trihalomethanes (524) <Volatile Halocarbons (524) ORGANIC NONPOTABLE/SOLiO ANALYSIS __ Purgeable Halocarbons (624/8260) __ Purgeable Aromatics (624/8260) I __ Coliform P/A (Public supplies) Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) H __ Coliform MPN (priv well, raw, sip) __ Fecal Coliform (ail samples) __ Total Trihalomethane Potential (510) __ Microextractables (504) __ Organochlorine Pesticides (608/8081) _ PCB’s (Arochlors) (608/8081) 1 __ Microscopic __ Macroscopic __ Pesticides/PCB screen (508) Herbicides (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SM18/6630) ri* ___ Other:; _ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) 1^: Refrigerated?yes no __ Pesticides (525) __ Carbamate Pesticides (531) __ Glycols in Water Acid Extractables (625/8270) i Chlorinated;?yes no __ Glyphosate (547) __ Diquat (549) Bpse Neutral Extractables (625/8270) _J;Y?3C/MS Unknown Scan B Free Chlorine Res:■ . mg/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) I Total Chlorine Res:: _ mg/L __ Haloacetic Acids (552) __ Other:_______________________________ B pH _____________ __ Other Pesticides (SMI8/6630) _ UCMR List 1 i RADIOCHEMICAL ANALYSIS IB ___ Radon ..__.MtBE Only (524) ■ ■ __ Other 1 INORGANIC ANALYSIS REQUESTED - Lai#; __ Color „ Turbidity Acidity __ Alkalinity Aluminum _z'Antimony __ Potassium 4^-'Selenium I Hi pH __ Conductivity __ Corrosivity (temp: "O __ Bromide __ Bromate/Chiorate/Chlorite __ Chloride - Arsenic . "Barium _vfBeryllium ./ST/er odium hallium i „ BOD (5 day) __ Cyanide __ Boron __ Vanadium ■ __ Carbonaceous BOD (5 day) Soluble BOD (5 day) __ Chemical Oxygen Demand __ Fluoride __ Hardness, Total as CaCOa __ Nitrogen, Ammonia as N _i. Cadmium __ Calcium, as CaCOa _ Calcium, Ca*’ ,-_xZinc

__ Metals/CN ■ Bi __ Dissolved Oxygen __ Nitrogen, Nitrate as N ^yChromium. Tcstal __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent: __ Semi-violatiies __ Total Organic Halides Nitrogen. Total Kjeldahl as N

1 ..iZCobalt __ Pesticides/PCB's __ Solids, Percent (%) __ Oil and Grease -A'Copper ___ Solids, Settleabie __ Phenol _Hlron __ Solids, Suspended 1CLP ■t __ Phosphorus Total as P _„,'Lead Solids, Total __ Phosphorus, Ortho as P __ Magnesium _TCLP-Metals __ TCLP-Pesticides ■ Solids, Total Dissolved Sulfates .-'Manganese _ TCLP-Herbicides __ Solids. Total Volatile _ Surfactants Mercury _ TCLP-Volatiles Blii Other:______ ___________ UV?!vl

s ..1:; Molybdenum _ TCLP-BNA's _i^-Nickel

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