Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document Oil ■BIBI I', ACCOj

Bl fnxVll! ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTFR COUNTY i ABORATORIFS AND RFSEARCII

I? BIBI 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 ■I NYS-E1.APN0. icBca Time/Date Set: Form A-70 (rev. 10/01)

I Sanspie Type (circle one): IIIIIIIIIIH ■f B ■ z

1. Potable ,T Non Pntohk? Troafod Bottle #'s: __r , ■ 2. Non Potable 4. Other Chain of Custody? J . Yes No

■ fill Time/Date Collected; Collected By;_____ ___________ _ ' ' Agency Code; Comments: PWS #;: . . Source ID; Type Descriptor: Collecteri From: Bill to. ■ Location’s/lndivldual's Name' Name/Company; Street: ■ Street________________ ________ : City/St/Zip i City/St/Zip: Identification of Source Phone#:__________ Fax#: Collection Point. CA,CH, Bl? _ Check#:j Amounts

BACTERIOLOGICAL ANAUSiS Lab#;:

I Lab#:___________________________ __ Heterotrophic Plate Count (hemodialysis & all others) ORGANIC POTABLE ANALYSIS __ Trihalomelhanes (524) ORGANIC NONPOTABLE.' SOLID ANALYSIS Purgeable Halocarbons (624/8260)

fl __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Volatile Aromatics (524) _ Purgeable Aromatics (624/8260) __ Acrolein & Acrylonitrile (8260)

B __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) Oil __ Microscopic __ Total Trihalomethane Potential (510) __ Microextractables (504) __ Organochlorine Pesticides (608/8081) __ PCB's (Arochlors) (608/8081) ■I __ Macroscopic __ Pesticides/PCB screen (508) __ PCB as Decachlorobiphenyl (508A) _ Herbicides {SM18/6630.8151) _ API __ Other Pesticides (SM18/6630) __ Other: ___ _________ _ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) Pesticides (525)

b __ Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) Acid Extractables (625/8270) __ Glyphosate (547) __ Base Neutral Extractables (625/8270) ii Chlorinated:? fH Free Chlorine Res;: yes no Diquat (549) GC/MS Unknown Scan Z - mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:; _ mg/L Haloacetic Acids (552) __ Other;________ ________ __ Other Pesticides (SMI 8/6630) _UCMRList1 RADiOCHEMICAL ANALYSIS „ MtBE Only (524) __ Radon Other:

INORGANIC ANALYSIS REQUESTED - i.nb#- .......... __ Color __ Bcidity / Zr-AUMfiinum: __ Potassium

I sii( __ Turbidity __ pH __ Conductivity __ Alkalinity __ Bromide __ Bromate/Chlorate/Chlorite __B Antimony _ Arsenic _ Barium _ Selenium _ Silver __ Sodium Bll __ Corrosivity (temp: .“C) __ Chloride __ Beryllium Thallium „ BOD (5 day) __ Cyanide __ Boron __ Vanadium ill ■ __ Carbonaceous BOD (b day) __ Fluoride __ Cadmium __ Zinc „ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs __ Chemical Oxygen Demand Nitrogen, Ammonia as N __ Calcium, Ca+2

I ■Bl __ Dissolved Oxygen __ Total Organic Carbon __ Total Organic Halides ___ Nitrogen, Nitrate as N __ Nitrogen. Nitrite as N __ Nitrogen, Total Kjeldahl as N ___Chromium, Total __ Chromium, Hexavalent __ Cobalt _ Metais/CN __ Volatiles _ Semi-vioiatiies

t ___ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease __ Copper __ Solids, Settieable __ Phenol Iron TCLP Ml _ Solids, Suspended __ Phosphorus Total as P Lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium SBI ___ Solids, Total Dissolved __ Sulfates __ Manganese __ TCLP-Pesticides __ TCLP-Herbicides Solids, Total Volatile _ Surfactants __ Mercury __ Other:______ _____________ _ TCLP-Voiatiles _ UV254 __ Molybdenum __ TCLP-BNAs __ Nickel ill ■I NYC-WTC_000074247