Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

i WESTCHESTER,COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 1 (914)231-1620 Fax (914) 231-1772 t NYS-ELAP No. 10108, (Time/Date Set: Form A-70 (rev.10/01) J Sample Type (circle one): 1. Potable' j 2. Non Potable 3. Non Potable Treated 4. Other Bottle #’s:

Chain of Custody? Yes___ No I I 1 Time/Date Collected: Comments: ’ Collected By: Agency Code: PWS #:_______ _ Source ID: Type Descriptor: 1 Collected From: Bill to: r I

1 •Location’s/lndividual’s Name-i. I Name/Company _ ! Street______________________ Street__________ City/SVZip__________________ City/St/Zip Identification of Source Phone#:________ Fax#: ,Collection Point CA,CH, Bl? Check#: Amounts. I BACTERIOLOGICAL ANALYSIS Lab#: Lab#:________________________ __ ORGANIC NON POTABLE/SOLID ANALYSIS?^ ORGANIC POTABLE ANALYSIS ■_1_ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) __ Volatile Halocarbons (524) __ Purgeable Halocarbons (624/8260) __ Purgeable Aromatics (624/8260) a __ Coliform P/A (Public supplies) J.*,.. ' Coliform MPN (priv well, raw, stp) J_ Fecal Coliform (all samples) __ Volatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Acrolein & Acrylonitrile (8260) _ Organochlorine Pesticides (608/8081) I 1 __ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) !■

i _L Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) __ 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) __ Diquat (549) iX''GC/MS Unknown Scan ' -'’t Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other:_______ __ Other Pesticides (SM18/6630) _UCMR List 1 IRADIOCHEMICAL ANALYSIS _MtBE Only (524) __ (Radon ;__ ' Other________________________ ■t X

■ INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity ’ ‘ Aluminum __ Potassium _ Turbidity __ Alkalinity z' Antimony - Selenium pH __ Bromide z Arsenic __ Silver _i Conductivity __ Bromate/Chlorate/Chlorite' Barium __ Sodium / /'K _1 Corrosivity (temp:. °C) __ Chloride _z_ Beryllium __ Thallium _i BOD (5 day) __ Cyanide __ Boron __ Vanadium ■i __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium Zinc __t Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOa CLP __I Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 _ Metals/CN __I Dissolved Oxygen __ Nitrogen, Nitrate as N _i_Chromium, Total __! Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Volatiles 1 __ Semi-violatiles _t Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Cobalt __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease __ Copper __ Solids, Settleable __ Phenol Iron __ Solids, Suspended __ Solids, Total __ Phosphorus Total as P __ Phosphorus, Ortho as P „ Lead __ Magnesium tCLP _TCLP-Metals __ TCLP-Pesticides’ I __ I Solids, Total Dissolved __ Sulfates Manganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants __ Mercury _ TCLP-Volatiles __ ' Other:______ ______________ _ UV254 - Molybdenum _ TCLP-BNA’s Nickel XI NYC-WTC_000074480