Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 O/ ■ I 3 (914)231-1620 Fax (914) 231-1772 MYS-EL‘aP No. 10108 Tirne/Date Set: Form A-70 (rev.10/01) 1 Sample Type (circle one): / I M.J’otable 3. Non Potable Treated Bottle #’s: 2. Non Potable 4. Other___________ Chain of Custody?___ Yes No Tirhe/Date Collected: '2- 2- ■'2.. £2' Comments: Collected By: / ' ■ ( /'U Agency Code: PWS #:______ Source ID: ;Type Descriptor:. Collected From; Bill to: 1 I Location’s/lndividuars Name Name/Company Street_________________ 1 Street City/St/Zip______________ I______ City/St/Zip Identification of Source I Phone#: Fax#: . I

Collection Point CA,CH, Bl? Check#: Amounts I ■i

r BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/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) I: , ■ __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081)

i ■__ Fecal Coliform (all samples) Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) __ Other:_____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) ' __ Pesticides (525) __ Glycols in Water ! Refrigerated?yes no ^Carbamate Pesticides (531) .. Acid Extractables (625/8270) T Chlorinated:? yes no __ Glyphosate (547) __ Base Neutral Extractables (625/8270)

I __ 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)' pH ___________ _UCMRList 1 J RADIOCHEMICAL ANALYSIS _MtBE Only (524) __ Radon

ri __ Other ___________________

INORGANIC ANALYSIS REQUESTED - Lab#: I

r ,__ Color __ Turbidity J_ Acidity I Alkalinity >/Aluminum Antimony __ Potassium _2Selenium ' ; I _ pH I Bromide ■''Arsenic ^Silver __ Conductivity I Bromate/Chlorate/Chlorite Barium __ Sodium __ Corrosivity (temp:. °C) I Chloride x'BervIlium ^TTiallium _ BOD (5 day) I Cyanide __ Boron __ Vanadium •__ Carbonaceous BOD (5 day) I Fluoride __ Cadmium ^''Zinc _ Soluble BOD (5 day) _L Hardness, Total as CaCOs __ Calcium, as CaCOa ~CLP T __ Chemicalpxygen Demand I Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Dissolved' Oxygen _Metals/CN I Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles < _ _ Total Organic Carbon I Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles I __ Total Organic Halides _L Nitrogen, Total Kjeldahl as N ^Cobalt f __ Pesticides/PCB's _ Solids, Percent (%) _1 Oil and Grease •''Cooper 1 __ Solids, Settleable I Phenol Y’lron tclp __ Solids, Suspended _ 1 Phosphorus Total as P Lead ' 1 _TCLP-Metals __ Solids, Total _ 1 Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __! Sulfates ^'Manganese __ TCLP-Herbicides __ Solids,-Total Volatile __ 1 Surfactants -Mercury _ TCLP-Volatiles _t_zOther:________ ^2______ I UV254 Molybdenum _ TCLP-BNA’s I _--■ Nickel

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