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 I st. , 2 Dana Road, Valhalla, New York 10595 A A- ’ o (914)231-1620 Fax (914) 231-1772 I NYS-ELAP No. 10108 ’ Time/Date Set: Q . Form AYO (rev. 10/01) i r 2/Cd/ Sample Type (circle one): Cd kMC c, I

^1. Potable 3. Non Potable Treated Bottle #'s: C-S 'C ■ T P Zi / *~/ ’-it- v

2. Non Potable 4. Other___________ Chain of Custody? Yes No Time/Date Collected: i Y; IS Comments: Collected By: C \a ( A f■ Y Agency Code: PWS #:________ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name■ /rJC hr P Name/Company Street i'' ? ’ >'• <. ut r’ Vr nr t Street_________ I City/St/Zip t V/A t n P i City/St/Zip Identification of Source Phone#:_______ Fax#: 1 Collection Point t . L.. I CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#: I Lab#:_______________________ I ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) I (hemodialysis & all others) j^irfVolatile Halocarbons (524) __ Purgeable Aromatics (624/8260) I __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) iifS/olatile 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) 11 __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) 1 ! _ API __ PCB as Decachlorobiphenyi (508A) __ Other Pesticides (SMI8/6630) 1 __ 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) __ 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 (SMI8/6630) pH ___________ 1 __ UCMR List 1 ! RADIOCHEMICAL ANALYSIS _MtBEOnly (524) __ Radon 1 __ Other____________________ f T 'i i' INORGANIC ANALYSIS REQUESTED - Lab#: I, __ Color __ Acidity -_--*Aluminum __ Potassium __ Turbidity __ Alkalinity ..-'Antimony '-Selenium _ pH __ Bromide '---'Arsenic jn'Silver __ Conductivity __ Bromate/Chlorate/Chlorite -'Barium __ Sodium __ Corrosivity (temp:. .°C) __ Chloride 2<rBeryllium ^■Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride Cadmium '--•Zi'nc __ 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 J^Chromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent I- __ Semi-violatiles' I __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N _-Cobalt __ Pesticides/PCB's __ Solids, Percent (%) __ Oil and Grease -■CoDper __ Solids, Settleable __ Phenol ^•Tron 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 I

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