Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■ '."'J s WESTCHESTER COUNTY LABORATORIES ANO RESEARCH it

ILMsMI o 2 Dana Road, Valhalla, New York 10595 • j ' I (914)231-1620 Fax (914) 231-1772 T/SEiAPNo 10 173 Time/Date Set; . ' Form A-70 (rev. 10/01) ■ ~

Hi -Sample Type ■ ■, ■ .7 Pol ib'o 3. Non Pr/nhlo Tfoafou Bottle #’s: ?>V.f JZ-;; ■ JOB 2. Non Potable 4. Other_____________ _ _________ ,____ , Time/Date Coliectedj^ Ci ' - " ____ ________ iL—i Chain of Custody?; Comments; .Yes . No

■I !■ Collected By: /j (H- Agency Code:: lj^B|j|jj||jl| Source ID: lype Descriptor;:

Collocled From; Bill to: Oil Location’s/lndividual's Name; Name/Company „

■I Street_________

■ Cu.v'St/Z:p. identification of Source____ , City/St/Zip; Phone#:: Fax#: Coliection F’oint^ CA.CH, Bl?, Check#: Amounts,

i BACTERIOi.OGiCAI.. ANALYSIS Lab#:; Lab#;__________________________ ; ORGANIC POTABLE ANALYSIS ORGANIC NONPO1ABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & ail others) __ Volatile 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) __ Microscopic __ Microextractables (504) „ PCB's (Arochlors) (608/8081) Pesticides/PCB screen (508) Herbi^3des(SM18/6630,8151) Macroscopic __ PCB as Decachlorobipheny! (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 Extractables (625/8270) Chlorinated:?yes no __ Glyphosate (547) Base Neutral Extractables (625/8270) __ Diquat (549) LHC/MS Unknow/n Scan Free Chlorine Res;; . mg/L; __ Chlorination Disinfection Byproducts (551) „ Phthalates {606MS) Total Chlorine Res:; - mg/L: __ Haioacetic Acids (552) __ Other:________________________ ________ Other Pesticides (SM18/6630) pH--------------------- __UCMRList1 RADiOCHEWIiCAL ANALYSIS __ MtBE Only (524) __ Radon __ Other; ■■ ■■ INORGANiC ANALYSIS REQUESTED - i.ah#: _. Color _ Aridity __ Potassium

■ __ Turbidity pH __ Alkalinity __ Bromide Anfimony ■J. Arsenic .(X Selenium ±1 Silver __ Conductivity Bromate/Chlorate/Chlorite J/ Barium __ Soditim __ Corrosivity (temp:°C) _ Chloride it. Beryllium Thallium BOD (5 day) __ Cyanide __ Boron __ Vanadium

■I _ Carbonaceous BOD (5 day) _ Soluble BOD (5 day) __ Fluoride __ Hardness, Total as CaCO;? __ Cadmium ___ Calcium, as CaCO.s V- Zinc

__ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca'2 _^hromium, Total „ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N _ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N _ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N iC Cobalt _ Pesticides/PCB's Solids, Percent (%) __ Oil and Grease Ji, Copper Solids, Settleable __ Phenol ZJ Iron ■11 tclp __ Solids, Suspended __ Phosphorus Total as P ±J Lead •ICLPMufois Solids, Total __ Phosphorus, Ortho as P; __ Magnesium _TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates Manganese _TCLF-Herbicides Solids, Tptel Volatile Surfactants Mercury TCLP-Volatiles 4Z Other; Q/ ?; _ UV254 V Molytxjenum ICir'BNAu X Nickel

■Hi NYC-WTC_000074248