Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM .V, ^.West^ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH s'-’, / V** ' ‘A •i 2 Dana Road, Valhalla, New York 10595 o/■ 1 (914) 231-1620 Fax (914) 231-1772 ?(JJ X 5 NyS-ELAP No. 10108 | Time/Date Set: Form A-70 (rev.10/01) .

Sample Type (circle one): 1. Potable 3. Non Potable Treated Bottle #’s: KiiVkLjwys I 1'T '' 2. Non Potable 4. Other : Chain of Custody? Yes___ No ’Time/Date Collected: Comments: I Collected By: 6. J Agency Code: PWS #: ____ Source ID: Type Descriptor; Collected From: Location’s/lndividual’s Name Ai. Bill to: Name/Company _ 1 I'S Street_________________ : Street_________ City/St/Zip______________ City/St/Zip Identification of Source Phone#:'_______ Fax#: Collection Point I <>iJ ---- I CA,CH, Bl? Check#: Amounts. J

BACTERIOLOGICAL ANALYSIS Lab#: ■ . 77777EZTZ '■" /' I / / Lab#:_______________________ ORGANIC POTABLE ANALYSIS ' ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count _ _ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Trihalomethanes (524) J __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics ‘(524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) ___Microextractables (504) _ PCB's (Arochlors) (608/8081) __ Microscopic __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) . '2 _ API ■__ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) __ Other:_____________________ __ Herbicides (515), __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water 1 Refrigerated?yes no __ Carbamate Pesticides (531) __ Acid Extractables (625/8270) ' 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 ______ ____ _UCMRList1 I RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ /Acidity __ Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony __ Selenium _ pH __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/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 CaCOs 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, Hexavalerit __ Semi-violatiles __ 'Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Cobalt __ Pesticides/PCB’s __ ‘ Solids, Percent (%) __ Oil and Grease __ Copper __ Solids, Settleable __ Phenol __ Iron ICLP __ Solids, Suspended '__ Phosphorus Total as P _Lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides _ _ Solids, Total Dissolved __ Sulfates __ Manganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants __ Mercury _ TCLP-Volatiles ‘ __ Other:_________________ _ UV254 __ Molybdenum __ TCLP-BNA’s __ Nickel i . NYC-WTC_000074398