Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

>>» AC'Cp ENVIRONMENI/AL SERVICES SAMPLE SUBMISSION FORM LLstcr WESTCHESTER COUNTY LABORATORIES AND RESEARCH ■ XA.COJH 2 Dana Road. Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 io; iime/Date Set: Form A-70 (rev.10/01)

Sample Type scireie one);: 1. Potable 3. Non Potable Treated Bottle #’sY;_____________ I 2. Non Potable: 4, Other_____________ : Chain of Custody?___ Yes____ ' No Ji Conunenis; Time/Date Collected;______ : Collected By:_____________ : Agency Code: PWS #:_______ _ Source ID: lype Descriptor:_____ GiJiIccled Froiii: cm to: LocatioiTs/lndividual s Name Name/Company Street: Street: CFv^St/Zip..,.. City/St/Zip : Identification of Source____ : Phone#: Fax#:

III Collection Point ,Y CA.CH, Bl?i Check#:: Amounts

RAC rERiOLOGiCAL ANALYSIS Lab#: Lab#:__________________________ _ ORGANIC POTAEiLt ANAL YSiS ORGANIC NONPOTABLE/ SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & aii others.) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Pubiic supplies) __ Coliform MPN (priv well, raw, stp): __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (a!! samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) PCB's (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) API __ PCB as Decachiorobiphenyl (508A) __ Other Pesticides (SMI8/6630) __ Other:) __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) Acid Extractabies (625/8270) Chlorinated:?yes no __ Glyphosate (547) __ Base Neutral Extractabies (625/8270) __ Diquat (549) GC/MS Unknown Scan Free Chlorine Res: .. mg/L Chlorination Disinfection Byproducts (551) ........ Phthalates (606M3) Total Chlorine Res; - mg/Li __ Haloacetic Acids (552) __ Other:______ _ _________________________ __ Other Pesticides (SM18/6630) pH _____________ _UCMRList1 RADIOCHEMICAL. ANALYSIS __MtBE Only (524) ___ Radon _ Other _ _____ _ _______________ ________

INORGANIC ANALYSIS REQUESTED - l.ohn ...... ... Ol __ Color __ Acidity Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony Selenium _ pH __ Bromide __ Arsenic Silver __ Conductivity __ Bromate/Chlorats/Chlorite __ Barium __ Sodium Corrosivity (temp: “C) __ 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 __ Chemical Oxygen Demand Nitrogen, Ammonia as N __ Calcium, __ Dissolved Oxygen __ Nitrogen, Nitrate as N _Metals.'CN __ Chromium, Total __ Total Organic Carbon __ Volatiles __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N .^Cobalt __ Pesticides/PCB's __ Solids, Percent (%) __ Oil and Grease __ Copper o __ Solids, Settleable __ Phenol __ Iron TCLP __ Solids, Suspended __ Phosphorus Total as P __ Lead _TCLP-Metals __ Solids, Total Phosphorus, Ortho as P __ Magnesium TCLP-Pesticldes __ Solids, Total Dissolved Sulfates __ Manganese _TCLP-Herbicidesi Solids, Total Volatile Surfactants __ Mercury _ TCLP-Volatiles __ Other:___________________ : _ UV254 __ Molybdenum __ TCLP-BNAs Nickel

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