Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM bcslcr: WESTCHESTER COUNTY LABORATORIES AND RESEARCH A'- IS sow 2 Dana Road. Valhalla, New York 10595 I Th, I -x (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108: fime/Date Set: Form A~7Q (rev. 10/01)

.Sample Type (circle one): p. Ims ' 1. Potable 3. Non Potable Treated Bottle #'s: _____________________ ___

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

Titne/Date Collec •d; , *'»__ Cominersis:

CoHected By:| .. V Ai/. Agency Code: PWS #;i „ Source ID: .Type Descriptor:: CnlloctCil From. Bill lo: LocatioR's/lndividual’s Name 0^1^ Name/Company Street___________________ _ Street:

City/St/Zip________________ : City/SVZip, Identification of Source Phone#:________ Fax#: Coliection Point ' VO I CA.CH, 31? Check#: Amount$,i

SACTt RIOL OGICAL ANAt YSiS Lab#: Lab#:;: ORGANIC POTABLE ANALYSiS ORGANIC NONPOTABI.E/SOUD ANALYSIS Heterotrophic Plate Count Trihalomethanes (524) Purgeabie Halocarbons (624/8260) (hemodialysis & all 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 (ail samples) __ Total Trihalomethane Potential (510) ....... Organochiorine Pesticides (608/8081) II __ Microscopic __ Microextractables (504) __ PCB’s (Arochlors) (608/8081) __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8151) __ Macroscopic __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) __ API __ Other:, .....Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) il ilii ........ 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) J\,^^SC/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) Phthalates (606MS) ■II _ _ Haloacetic Acids (552) Other:i BII Total Chlorine Res:mg,/L Other Pesticides (SM18/6630) UCMR List 1 ■ I RADfOCHtMICAL. ANAIYSIS __Radon .... Other: ._MtBE Only (524)

INORGANIC ANALYSIS REQUESTED ■ LauC Color __ Acidity "^✓■Aluminum iiiillllBS Turbidity __ Aikaiinity •^/Antimony ^Selenium lii ... - pH __ Bromide 'tS Arsenic ^■Silver __ Conductivity __ Bromate/Chlorate/Chlorite •a=<Barium __ Sodium „ Corrosivity (temp: “O: __ Chloride .„^Beryilium i^Thailium il __ BOD (5 day) __ Cyanide __ Boron __ Vanadium „ _ Carbonaceous BOD (5 day) __ Fluoride JiCadmium x^'Zinc __ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCO:i Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 MetalsZCN __ Dissolved Oxygen __ Nitrogen, Nitrate as N .j^ehromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent: 1 Oiii __ Total Organic Halides __ Solids, Percent (%) __ Nitrogen, Total Kjeldahl as N __ Oil and Grease j:^Cobalt _rc. Copper __ Semi-violatiles __ Pesticides/PCB's __ Solids, Settleable __ Phenol Iron TCI P __ Solids, Suspended __ Phosphorus Total as P Lead ■I __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium _„.TCLP-Metais __ TCLP-Pesticides Solids, Total Dissolved _ Sufetes ..^s^tTvIanganese __ TCLP-Herbicides __ Solids. Total Volatile Surfactants Mercury „ TCLP-Voiatiles Other:\ __ UV254 ...■Molybdenum _ TCLP-BNA's Nickel

NYC-WTC_000074269