Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

EhiVSRONMENTAL SE RVICES SAMPLE SUSMiSSION FORM ster vconi WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla. New York 10595 (914)231-1620 Fax (914) 231-1772 it lot NYS-ELAP No. 10108 Time/Date Set; Form A-70 (rev. 10/01)

SaiQple Type (circle one): II ■ ■ ■ ■ ^..Potable 3. Non Potable Treated Bottle #'s:

2. Non Potable 4. Other________________ Chair’ of Custody? Yes No

Time/Date Collected: ___- ■_____ '_____ Comiiii.-nts. Collected By: . . _LiL£_L_^ Agency Code: PWS #:_______ _ Source ID; Type Descriptor:

Collected From; fiik to

Location’s/lndividual’s Name Name/Company;

Street____________________ ; Street____________ ,

City/St/Zip_______________ , Citv'SCZip J

identification of Source____ ; Phone#:__________ . Fax#::

Collection Point Check#; Amounts CA,CH, Bl?; ■ BACTERIOLOGICAL ANALYSIS Lab#: Lab#;; ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLt/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Coliform MPN (priv well, raw. stp) Total Trihalomethane Potential (510) __ Organochiorine Pesticides (608/8081) Fecal Coliform (all samples) __ Microextractables (504) PCB’s (Arochlors) (608/8081) __ Microscopic __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8151) _ Macroscopic __ PCB as Decachiorobiphenyi (508A) __ Other Pesticides (SM18/6630) API __ Herbicides (515) Petroleum Hydrocarbon Scan (310-13) III __ Other;_______________________ __ Pesticides (525) __ Glycols in Water ■I Refrigerated?yes no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) __ Glyphosate (547) B9«rfJeutral Extractables (625/8270) Chlorinated:? yes no Diquat (549) _k''6c/MS Unknown Scan Free Chlorine Res:j - mg/L __ Chlorination Disinfection Byproducts (551) Phthalates (606MS)

r■I Total Chlorine Res:___ ; pH___ _________

RADIOCHEMICAL ANALYSIS - mg/L; Haloacetic Acids (552) __Other Pesticides (SM18/6630) UCMR List 1 MtBE Only (524) Other:__________________ _ ____________

■I ___ Radon __ Other;

INORGANIC ANALYSIS REQUESTED -: 7^ ___ ____ __ Color Acidity Al Aluminum __ Potassium , 11 II Turbidity __ Alkalinity t-YAntimony izSelenium pH __ Bromide 21 Arsenic Silver im Conductivity __ Bromate/Chtorate/Chiorite ill Barium __ Sodium

F Corrosivity (temp:°C) __ Chloride .H, Beryllium IZ Thallium BOD (5 day) __ Cyanide __ Boron Vanadium __ Carbonaceous BOD (.5 day) __ Fluoride __ Cadmium l^fZinc __ Soluble BOD (5 day) __ Hardness. Total as CaCOs __ Calcium, as CaCOa

It __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 J^hromium, Total __ Metals/CN 1

rF __ Dissolved Oxygen __ Nitrogen, Nitrate as N _ Volatiles __ Tote! Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles Total Organic Halides __ Nitrogen, Total Kjeldahl as N _i/ Cobalt __ Pesticides/PCB's Solids, Percent (%) __ Oil and Grease Copper Solids. Settleable __ Phenol V Iron ICLP Solids. Suspended __ Phosphorus Total as P ..i;Lead __TCLP-Metals 11 __ Solids, Total Solids, Total Dissolved Phosphorus, Ortho as P __ Sulfates __ Magnesium V Manganese __ TCLP-Pesticides . _TCLP-Herbicides Solids, Total \^itile Surfactants L' Mercury TCLP-Volatiles P” Other: s-V'y.._____ . _ UV254 Molybdenum _ TCLP-BNAs

I ill y. Nickel

NYC-WTC_000074272