Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914)231-1772 NYS-ELAP No. 10108 Time/Date'Set: Form A-70 (rev. 10/01)

Sample Type (circle one): /H?yotable 3. Non Potable Treated Bottle #’s: #

7?Non Potable 4. Other Chain of Custody? Yes___ No Time/Date Collected: 6 t> Comments: Collected By; _ ____________________ Agency Code: PWS #:_________ Source ID: Type Descriptor: Collected From: Bill to; Location's/lndividual's Name Name/Company Street_____________________________ Street__________ C-’ City/St/Zip_________________________ City/St/Zip Identification of Source Phone#:________ _ Fax#: Collection Point. 2 c CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:___________________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count _^;^halomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) _L;^wlatile Halocarbons (524) __ Purgeable Aromatics (624/8260) o __ Coliform P/A (Public supplies) _ir<7olatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) i O __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081)0'; __ Microscopic __ Microextractables (504) __ PCB's (Arochlors) (608/8081) ■"< __ Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,8151) i __ Macroscopic __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMl'8/6630) ; _ API __ Other;_________ __ ____________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan __ Pesticides (525) __ Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) __ Glyphosate (547) __ Base Neutral Extractables (625/8^75) Chlorinated:? yes no __ 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 (SM18/6630) pH ___________ __ _UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBE Only (524) ___ Radon __ Other_______________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ 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 CaCOs __ Calcium, as CaCOa CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles • __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ 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 _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

NYC-WTC_000074093