Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

1 3Jfestchester ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH ,1^ ACCo,

2 Dana Road, Valhalla, New York 10595 K (914)231-1620 Fax (914)231-1772 / NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.10/01) ■ c: ? /' ^'7 5' Sample Type (circle one): 1. Potable-' 3. Non Potable Treated Bottle #'s: ■■■• / S' ?• ■ 2. Non Potable 4. Other___________ Chain of Custody?___ Yes No Time/Date Collected:: 1.^ c Comments: Collected By: Agency Code: PWS #:______ Source ID: Type Descriptor: if. Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street Street_______ City/St/Zip \i ! i I ;7 iU City/St/Zip Identification of Source Phone#: Fax#: ? Collection Point nt t CA,CH, Bl? Check#: Amounts

S' BACTERIOLOGICAL ANALYSIS Lab#:_______________________ __ Heterotrophic Plate Count Lab#:

ORGANIC POTABLE ANALYSIS __ Trihalomethanes (524) ORGANIC NONPOTABLE/SOLID ANALYSIS __ 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) _ 1 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 (SM18/6630) _ API Other:____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) F' __ 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) r __ Diquat (549) _1-'GC/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other:_______________ ;____________ T _ Other Pesticides (SM18/6630) pH ___________ _ UCMR List 1 RADIOCHEMICAL ANALYSIS __ MtBE Only (524) I __ Radon __ Other____________________ / ■-■I

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INORGANIC ANALYSIS REQUESTED - Lab#: ; * I — __ Color __ /Acidity Aluminum __ Potassium __ Turbidity __ Alkalinity ■Antimony _ _Selenium _ pH __ Bromide __ .Arsenic _ .'Silver __ Conductivity __ Bromate/Chlorate/Chlorite Barium __ Sodium Corrosivity (temp: °C) __ Chloride Beryllium _^Tha!lium _ 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 __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Dissolved Oxygen _ Metals/CN __ 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 __ Pesti'cides/PCB’s __ Solids, Percent (%) __ Oil and Grease _ ;Copper __ Solids, Settleable _ Phenol -i^lron TCLP __ Solids, Suspended __ Phosphorus Total as P _5Lead _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 r^Other: _ UV254 Molybdenum _ TCLP-BNA's _j_,Nickel

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NYC-WTC_000074434