Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

aap®'" WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 Si X

NYS-ELAP No. 10108 Time/Date Set; Form A-70 (rev. 10/01)

^mple Type (circle one): /GT^otable . 3. Non Potable Treated Bottle #’s:. #

Non Potable 4; Other Chain of Custody? Yes No Time/Date Collected: Comments: Collected By;__________ Agency Code; PWS #; ________ Source ID; Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street_________________ Street_________ City/St/Zip______________ City/St/Zip Identification of Source Phone#:_______ Fax#: Collection Point. CA.CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLr ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count _4zrfihalomethanes (524) __ Purgeable Halocarbon;; ■ (624/8260) (hemodialysis & all others) _j/^0t&tile Halocarbons (524) __ Coliform P/A (Public supplies) __ Purgeable Aromatics (624/8260) ' / _5volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) L.T __ Coliform MPN (priv well, raw, stp) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (do8/8O8T) __ Fecal Coliform (all samples) __ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/80810 " __ Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SMI8/6630,81510 _ API' __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630^- __ Herbicides (515) __ Petroleum Hydrocarbon ScarP^3T0-13) __ Other:_____________________ __ Pesticides (525) __ Glycols in Water -Refrigerated?-------- ves'~ no CaTbarhate^Pesticicles^(531)" “TZTAcid Extractables”(625/8270) Chlorinated;? ___ yes no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) __ Diquat (549) __ GC/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other:_______ ____________________ __ Other Pesticides (SMI8/6630) pH ___________ _UCMRList 1 RADIOCHEMICAL ANALYSIS _MtBE Only (524) __ Radon __ Other __ _________________

INORGANIC ANALYSIS REQUESTED - Lab#: I __ Color __ Acidity __ Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony __ Selenium _ pH __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium _ Sodium __ 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 CaCOa CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Metais/CM __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiies __ 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 __ Lead __ TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates __ Manganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants __ Mercury __ TCLP-Volatiles __ Other;_________________ _ UV254 __ Molybdenum _ TCLP-BNA's __ Nickel

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