Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

J' ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ACCo.

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: ^/zForm A-70 (rev. 10/01)

i Sample Type (circle one): *7 1. Potable :3. Non Potable Treated Bottle #'s: 2. Non Potable 4. Other Chain of Custody? Yes No ./ /: \ /-A T--____________ Comments: Time/Date Collected: Collected By: Agency Code: / L Z' i L L PWS #:________ Source ID: Type Descriptor: Collected From: I , Bill to: «■

Location’s/lndividual’s Name ! f' ’ Ir Name/Company Street_________________ Street_______ City/St/Zip______________ City/SVZip Identification of Source Phone#: Fax#:

I- Collection Point / 6J CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:______________________ ORGANIC POTABLE ANALYSIS . I i ( /ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) f / __ 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 (SMI 8/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI8/6630)

I __ Other:_____________________ __ Herbicides (515) __ Pesticides (525) __ Petroleum Hydrocarbon Scan (310-13) __ 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 I Total Chlorine Res:mg/L pH ___________ ___ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) __ Other Pesticides (SMI8/6630) _ Phthalates (606MS) * __ Other:_________________________ ( _UCMR List 1 RADIOCHEMICAL ANALYSIS __ MtBE Only (524) __ Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#. __ Color __ /Acidity __ Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony __ Selenium _ pH __ Bromide __ Arsenic __ Silver _ Conductivity __ Bromate/Chlorate/Chlorite __ Barium __ Sodium __ 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 __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ ■clF^ _ 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 I CLP __ Solids, Suspended __ Phosphorus Total as P __ Lead •? __ TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides 7 __ Solids, Total Dissolved _ Sulfates __ Manganese __ ,TCLP-Herbicides __ Solids, Total Volatile __ Surfactants __ Mercury __ TCLP-Volatiles __ Other:_________________ _ UV254 __ Molybdenum _'TCLP-BNAs __ Nickel

NYC-WTC_000074455