Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ACCo*^ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM IM ■■■I H ■Il Aicnitt WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 1 -X.

NYS-ELAP No. 10108 Time/Date Set? Form A-70 (rev. 10/01)

■ Sample Type (circle one): Hill ...... ■■■I «'

ft 1..Potable 3. Non Potable Treated Bottle #’s: _ ________

2. Non Potable 4. Other Chain of Custody?: __ Yes No

Time/Date Coiiected: :j Comments. . .

o Coiiected By:_________ ____ : Coiiected From- Agency Code: _ _____ j PWC# Bill to- . . Source ID: Type Descriptor:

I Location's/lndividual’s Name- Strael Name/Cornpany Street•

I■ City/St/Zip, identification of Source____ : City'ShYic Phone#:: .. Fax#:. Collection Point___________ : CA.CH, Bl?.J Check#: Amounts ■ BACTERIOLOGICAL ANALYSIS Lab#:: Lab#:__________________________ : ORGANIC POTABLE ANAi..YSIS ORGANIC NONPO fABLE/SOLID ANAi.YStS lii __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) Mi (hemodialysis & al! others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Volatile ^romatics (524) __ Acrolein & Acrylonitrile (8260) „ Coliform MPN (priv well, raw, stp) __ Total Trftaiomethane Potential (510) __ Organochiorine Pesticides (608/8081) IB ___ Fecal Coliform (all samples) __ Microextr|ctab!es (504) PCB's (Arochlors) (608/8081) __ Microscopic __ Pesticidef/PCB screen (508) _ Herbicides (SM18/6630,8151) _ Macroscopic __ PCB as ^ecachlorobiphenyl (508A} _ Other Pesticides (SM18/6630) ■ . API Other:_______________________ __ Herbicides (515) Pesticides (525) Petroleum Hydrocarbon Scan (310-13) Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) _ Glyphosate (547) _ Base Neutral Extractables (625/8270) Chlorinated:? yes no 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)

I pH____ ________ ________________ RADlOCHEMKi^HANXUA^ .... „._UCMRList1 .... MtBE Only (524) _ _Radon __ Other:

I INORGANIC ANALYSIS REQUESTED - Lnh;; __ Color Acidity V Aluminum __ Potassium __ Turbidity _ Alkalinity __ Antimony Selenium

■i pH __ Bromide __ Arsenic j.- Silver _ Conductivity __ Bromate/Chlorate/Chlorite Barium __ Sodium __ Corrosivity (temp;”0) __ 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/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N ___ Chromium, Total _ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiies __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N _ Cobait __ Pesticides/PCB's ■I :|l|i __ Solids. Percent (%) „„ Solids, Settleable __ Oil and Grease __ Phenol __ Copper ■__ iron IBIIII tclp __ Solids, Suspended _ Phosphorus Total as P ' Lead __ TCLP-Metais __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium iCl.i'-Pesi^cMes __ Solids, Totui Dissolved __ Sulfates Manganese _TCLP-Herbicides Solids, Total Volatile _ Surfactants .j_ Mercury TCLP-Voiatiles ,__ Other;: ___ UV254 __ Molybdenum TCLP-BNA's Nickel

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