Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

.1 .f Vit’ACCo ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York' 10595 ,5 (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01) A ? .5 ‘ Sample Type (circle one): 1. Potable 3. Non Potable Treated Bottle #’s: I 2. Non Potable 4. Other_____________ Chain of Custody? Yes___ No J Time/Date Collected:’ - Comments: i Collected By: __j________ Agency Code: PWS #:_________ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street____________________ City/St/Zip; Identification of Source Street__________ City/St/Zip Phone#:________ Fax#: I Collection Point; CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:__________________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Volatile Halocarbons (524) __ Volatile Aromatics (524) ;__ Purgeable Aromatics (624/8260) __ Acrolein & Acrylonitrile (8260) 4 ' si __ Fecal Coliform (all samples) __ Microscopic __ Macroscopic __ Total Trihalomethane Potential (510) __ Microextractables (504) Pesticides/PCB screen (508) __ Organochlorine Pesticides (608/8081) _ PCB’s (Arochlors) (608/8081)1 _ Herbicides (SM18/6630,8151) , ■ 1 I’I _ 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) Chlorinated:? yes no __ Glyphosate (547) __ Base Neutral Extractables (625/8270)’ 5 __ Diquat (549) r GC/MS Unknown Scan 1: Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L _ Haloacetic Acids (552) __ Other:_______________ •s. __ Other Pesticides (SMI8/6630) pH ____________ _

RADIOCHEMICAL ANALYSIS ___ Radon _UCMRList 1 _MtBE Only (524) j __ Other_____________ ______ ’ J i /. Ih ! ' INORGANIC ANALYSIS REQUESTED - Lab#: X-Y / ‘"7 .. _ Color __ Acidity ’ J:; Aluminum __ Potassium __ turbidity __ Alkalinity __ Antimony ^'Selenium '»■

_ pH __ Bromide ... . Arsenic Silver » I t __ Conductivity __ Bromate/Chlorate/Chlorite Barium __ Sodium I 1 __ 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 .CLP?g»’ __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 _ Metals/CN ■"i' __ Dissolved Oxygen __ Nitrogen, Nitrate as N _t;:.Chromium, Total 4 1“ __ 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 __ i 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 _ TCLP-Volatiles Other:________;___________ __ UV254 ■__ Molybdenum _ TCLP-BNA’s __ Nickel

NYC-WTC_000074400