Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM uAfetchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 NYS-ELAP No; 10108 ; Time/Date Set: Form A-70 (rev.10/01) 7, f-------------------- Sample Type (circle one): ( (^Potable 3. Non Potable Treated Bottle #’s:

I 2. Non Potable Time/Date Collected: Collected By: L- 4. Other_____________ r< - M: -; 7 z Agency Code; Chain of Custody? Comments: PWS #:_________ Yes No

Source ID: Type Descriptor: V "/< 7 I

I Collected From: Bill to: Location’s/lndividual’s Name N \\ C, T)/ - H Name/Company r- Street Street__________ City/St/Zip N M iuY?' City/St/Zip Phone#;________ Fax#;

rr •K Identification of Source____________________________ Collection Point tS i t E_________________ CA,CH, Bl? Check#; Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:___________________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Purgeable Halocarbons (624/8260) __ Trihalomethanes (524) (hemodialysis & all others) --VoTatile Halocarbons (524) __ Purgeable Aromatics (624/8260) It __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _::.'-\?olatile Aromatics (524) __ Acrolein & Acrylonitrile (8260)

I __ Fecal Coliform (all samples) __ Microscopic __ Total Trihalomethane Potential (510) _ Microextractables (504) __ Pesticides/PCB screen (508) __ Organochlorine Pesticides (608/8081) _ PCB’s (Arochlors) (608/8081) _ Herbicides (SM18/6630,8151) __ Macroscopic __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SMI 8/6630) _ API __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Other:_______________________ __ 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) _ir^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 (SMI8/6630) pH --------------------- _UCMR List 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) _Radon __ Other_______________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity _iZ^luminum __ Potassium __ Turbidity __ Alkalinity .-'■Antimony i^'Selenium _ pH __ Bromide .^/Arsenic _xSilver __ Conductivity __ Bromate/Chlorate/Chlorite j^Barium __ Sodiurn _ Corrosivity (temp:. .°C) __ Chloride j^Beryllium .^Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride jXCadmium ^■''^inc __ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOa CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ _Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N ^Chromium, Total __ Volatiles r __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N i^Cobalt _2. Pesticides/PCB's __ Solids, Percent (%) __ Oil and.Grease ''Copper __ Solids, Settleable __ Phenol .i::dron tCLP __ Solids, Suspended __ Phosphorus Total as P j:;:fLead __ TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates --'''Manganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants i-Mercurv _ TCLP-Volatiles "■''Other: UV254 J::'Molybdenum __ TCLP-BNA’s _tfNickel g I____ i. NYC-WTC_000074411