Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ACC{,„ ENViRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCIirSTER COUNTY LABORATORIES AND RESEARCH: I' I 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231^772; a I) , H 1 u C h NYSYLAPNo. 10108 Time/Date Set: 1 ' T A .Y Form A-70 (rev. 10/01)

■ II lie Type {circle one): 1. Potable: 3. Non Potable Treated Bottle #’s:_________________ L 1Y- ___________ .. . 2. Non Potable 4. Other . . -.Yy.-___ 1____ I_____ : Chain of Custody?Yes No t Time/Date Collected 1' A '' ) Comments-............................................................. ■■ Collected By:__ _____ LXMIcX”Agency Code:: PWS #:. __ Source ID:Type Descriptor: fSs Collected Fioin: Bit! tu

Location’s/individuai’s Name Name/Company Street............................ Street: Ip City/St/Zip___ _____ ____. City/St/Zip i Identification of Source Phone#: ■ Fax#: it Sfcll Collection Point sb CA.CH, Bl? Check#: Amounts,

BACTERIOLOGICAL ANALYSIS Lab#: „

11 Lab#: \

r ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeabie Aromatics (624/8260) fc: ■■■ __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw. stp) __ Fecal Coliform (all samples) Volatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Acrolein & Acrylonitrile (8260) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) PCB’s (Arochlors) (608/8081) __ Macroscopic .. .. Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8151) PCB as Decachiorobiphenyl (508A) __ Other Pesticides (SMI8/6630) _ API __ Other:__ _____________ __ _____ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) & Pesticides (525) __ Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) Acid Extractabies (625/8270) Chlorinated:?yes no __ Glyphosate (547) . J3ase Neutral Extractabies (625/8270) Diquat (549) X GC/MS Unknown Scan Free Chlorine Res;: . mg/L __ Chlorination Disinfection Byproducts (551) ........ Phthalates (606MS) Ml Total Chlorine Res:: mg/L Haloacetic Acids (552) Other:__________ ....__ _________________ __ Other Pesticides (SM18/6630) pH_____________ III _UCMRList1

■ RADIOCHEMICAL ANALYSIS _._Radon „ Other________________________ MtBE Only (524)

INORGANIC ANALYSIS REQUESTED - i ,.h# Mlluminum ___ Color __ Acidity __ Potassium ___ Turbidity Alkalinity -^"Antimony .2w-Seienium I _ pH __ Bromide _C;Arsenic j,^i'iver __ Conductivity __ Bromate/Chlorate/Chloritei ;<Barium __ Sodium __ Corrosivity (temp:. .”0) __ Chloride Beryllium j^'Tliallium BOD (5 day) __ Cyanide __ Boron __ Vanadium Carbonaceous BOD (5 day) __ Fluoride __ Cadmium j!«Xinc Soluble BOD (5 day) __ Hardness, Total as CaCO - __ Calcium, as CaCOs Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium. Ca« Dissolved Oxygen „ Metals/CN __ Nitrogen, Nitrate as N _ijehromium, Total _ Volatiles Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __itCobalt Pesticides/PCB’s _ Solids, Percent (%) _ Oil and Grease ...^Copper __ Solids, Settleable __ Phenol JFon tclp __ Solids, Suspended __ Phosphorus Total as P .'Y.uPd _ TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ Solids, Total Dissolved __TCLP-Pesticides Sulfates --Manganese _ TCLP-Herbicides __ Solids, Total Volatile ___ Surfactants Mercury „ TCLP-Voiatiles _^zOther: __ UV254 __ Molybdenum __L Nickel TCLP-BNA'S

NYC-WTC_000074245