Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

I ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM '.AVestchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 i‘ (914) 231-1620 Fax (914) 231-1772 NYS-ELAPNo. 10108 ' j I Time/Date Set: Form A-70 (rev. 10/01) "

Sample -Type (circle one): -r ..Y .'.'3 [ 1. Potable 3. Non Potable Treated Bottle #’s: / '** f'2. Non Potable II 4. Other Chain of Custody? Yes No 1 Time/Date Collected: Comments: 1 'i Collected By;" Collected From: Agency Code: PWS #:________ Bill to: Source ID:. Type Descriptor: 1 Location’s/lndividual’s Name Name/Company i Street_________________ Street ________ ' City/St/Zip______________ Lldentification of Source Collection Point City/St/Zip Phone#:_______ Fax#: I •M ! CA,CH, Bl? Check#: Amounts I BACTERIOLOGICAL ANALYSIS Lab#: '5 Lab#:_____________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS t d Heterotrophic Plate Count I (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) ‘ __ Coliform P/A (Public supplies)* __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) ’ __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) i __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) , J _L Microscopic ■,__ Microextractables (504) _ PCB’s (Arochlors) (608/8081) I Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,8151) ’ ' _ API :_ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI8/6630) ' _ Other;____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13), __ Pesticides (525) _ Glycols in Water r' 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 Total Chlorine Res:_______ mg/L __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552). _ Phthalates (606MS) __ Other:__________________________ ■I pH RADIOCHEMICAL ANALYSIS __ Radon __ Other Pesticides (SM18/6630) _UCMR List 1 _MtBE Only (524) 1' 1 __ Other‘

INORGANIC ANALYSIS REQUESTED - Lab#: I ! 3 __ Color __ Acidity __ Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony -__ Selenium 3 — pH __ Bromide _ Arsenic __ Silver / __! Conductivity __ Bromate/Chlorate/Chlorite __ Barium' __ Sodium __ Corrosivity (temp:°C) __ Chloride __ Beryllium __ Thallium .1“ ■ 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 __ I Chemical Oxygen Demand __ Nitrogen, Ammonia as N ' __ Calcium, Ca*^ __ . Dissolved Oxygen __ Metals/CN __ Nitrogen, Nitrate as N _Chromium, Total __ .Total Organic Carbon __ Volatiles _ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ I Total Organic Halides __ Semi-violatiles __ Nitrogen, Total Kjeldahl as N __ Cobalt __ ' Solids, Percent (%) _ Pesticides/PCB’s __ Oil and Grease __ Solids, Settleable __ I Solids, Suspended __ Phenol __ Phosphorus Total as P __ Copper __ Iron __ Lead TCLP i _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ 'Solids, Total Dissolved I __ TCLP-Pesticides __ Sulfates __ Manganese __ TCLP-Herbicides __ 'Solids, Total Volatile __ Surfactants __ Mercury 'other; __ I -______________ _ TCLP-Volatiles . __ UV254 __ Molybdenum _ TCLP-BNA's __ Nickel

NYC-WTC_000074478