Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Mfe§tchester 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): J Potable 3. Non Potable Treated Bottle #'s:, 4- 2. Non Potable 4. Other Chain of Custody?___ Yes___ No I Time/Date Collected: IfI *YL SU, Comments; i'T 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 POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count _^rT^alomethanes (524) (hemodialysis & all others) __ Purgeable Halocarbons (624/8260)3 -l _LxV^tile Halocarbons (524) __ Purgeable Aromatics (624/3260) __ Coliform P/A (Public supplies) _Jr<7olatile Aromatics (524) _ Acrolein & Acrylonitrile (82p0) 2"; __ Coliform MPN (priv well, 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 (SMI8/6630,8151 __ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI 8/663 __ Other:_____________________ _ Herbicides (515) __ Petroleum Hydrocarbon Sca'n^„c(3i&-4j _ 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 (SM18/6630) pH ___________ __ UCMRList 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 CaCOa __ Calcium, as CaCOa __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Metal s/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 ICLP __ Solids, Suspended ■ __ Phosphorus Total as P __ Lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates __ Manganese __ T CLP-Herbicides __ Solids, Total Volatile __ Surfactants __ Mercury _ TCLP-Volatiles __ Other: __ ______________ UV254 __ Molybdenum _ TCLP-BNA's __ Nickel

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