Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

I ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 < I-*X ■ I '-T (914)231-1620 Fax (914)231-1772 NYS-ELAP No. lOlSTTO Time/Date Set: Form A-70 (rev. 10/01) |

Sample Type (circle one): .1 Bottle #’s: t ,1. Potable 3. Non Potable Treated 2. Non Potable ,4. Other Chain of Custody?___ Yes __ __No 1 Time/Date Collected: Comments: u." Collected By: Agency Code: PWS #:________ Source ID: Type Descriptor: '•fi

Collected From: Bill to: 35 Location’s/lndividual’s Name Name/Company’. Street_______________ __ Street_________ 1

City/St/Zip________________ City/St/Zip Identification of Source Phone#: Fax#: Collection Point CA,CH, Bl? Check#: Amounts I 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) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all 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) __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides' (SMI8/6630) _ API Ji __ Other: ___ ____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ 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) 221 GC/MS Unknown Scan , Free .Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) Total Chlorine Res: . mg/L __ Haloacetic Acids (552) Other:________________________________ pH _______ __ Other Pesticides (SM18/6630) T 1* _UCMR List 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) ___ Radon __ Other__________ _____________ / i I

INORGANIC ANALYSIS REQUESTED - Lab#: V .J \ __ Color __ Acidity ' ■21. Aluminum __ Potassium __ Turbidity __ Alkalinity Antimony - Selenium _ pH . __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium __ Sodium __ Corrosivity (temp:. “C) __ Chloride ■ ■ Beryllium 2_’ Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium _J Zinc ,t __ Soluble BOD (5 day) __ Hardness,.Total as CaCOa __ 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, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N < ,___ Cobalt __ Pesticides/PCB's __ Solids, Percent (%) __ Oil and Grease Copper __ Solids, Settleable __ Phenol __ Iron TCLP __ 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 ' ■ Other: L _ TCLP-Volatiles _ UV254 Molybdenum _ TCLP-BNA's Nickel

NYC-WTC_000074399