Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document Xi* AC Co ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH .0

2 Dana Road, Valhalla, New York 10595 O ■

(914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set; Forrh A-70 (rev. 10/01)

imple Type (circle one); JyPotable 3. Non Potable Treated Bottle #'s:

2. Non Potable 4. Other_________ Chain of Custody? Yes___ No Time/Date Collected:: {2) 6t;z7i_____ 02- 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 ------------- I CA,CH, Bl? Check#; Amounts I

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:___________________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLIDANALYSiS __ Heterotrophic Plate Count _y^Trihalomethanes (524) _ Purgeable Halocarbons (624/8260) Cu (hemodialysis & all others) _^Dlatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260)! __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microextractables (504) __ PCB's (Arochlors) (608/8081)4;:^ __ Microscopic __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,8151) j ’ __ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) ' __ Other:________________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water Refrigerated?yes___ no __ ^Carbamate Pesticides (531) __ Acid 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 _____________ _UCMRList1 J

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/CM __ 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-Yolatiles __ Other;___________________ UV254 __ Molybdenum _ TCLP-BNAs __ Nickel

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