Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM festehester ^fegov.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 SI 1 o/ I I

NYS-ELAP No. 10108 v \ Time/Date Set; ./Form A-70 (rev. 10/01)

Sample Type (circle one). Bottle #’s: i / It' ■■ 1. Potable • :3. Non Potable Treated i I 2. Non Potable 4. Other_____________ Chain of Custody? Yes No A Comments: Time/Date Collected: Collected By:L Agency Code: PWS #:_________ Source ID: _Type Descriptor:

Collected From: Bill to:

Location’s/lndividual’s Name Name/Company

Street_______________ .zi./ .A Y Street__________ City/St/Zip___________ City/St/Zip I Identification of Source Phone#:________ Fax#: ! Collection Point CA,CH, Bl? Check#: Amounts

& Lab#: BACTERIOLOGICAL ANALYSIS Lab#:__________________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) S __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _2' Volatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Acrolein & Acrylonitrile (8260) __ Organochlorine Pesticides (608/8081) __ Fecal Coliform (all samples) __ Microextractables (504) __ PCB's (Arochlors) (608/8081) __ Microscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630.8151) __ Macroscopic __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) __ API __ 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) h Free Chlorine Res:mg/L __ Diquat (549) __ Chlorination Disinfection Byproducts (551) __ GC/MS Unknown Scan _ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other:_____________________________ _ Other Pesticides (SM18/6630) pH _____________ _UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBEOnly (524) ___ Radon __ Other_______________________ ( INORGANIC ANALYSIS REQUESTED - Lab#: / z z-' __ 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 CaCOs CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 _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 TCLP __ Solids, Suspended __ Phosphorus Total as P __ Lead _JTCLP-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-BNAs __ Nickel

NYC-WTC_000074458