Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

! ACCft ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 4 o//■ ■

* Time/Date Set: I (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. TOI 08 Form A-70 (rev.l6/01) 1 f Sample Type (circle one): : 1. Potable 2. Non Potable Time/Date Collected: 3. Non Potable Treated 4. Other___________ 11'1 Fr Bottle #’s: Chain of Custody? Comments: Yes___ No I Collected By: ' Collected From: 1 Location’s/lndividual’s Name Agency Code: PWS #:________ Bill to: Name/Company Source ID: Type Descriptor: 1I ! j street____ _____________ Street_________ City/St/Zip______________ City/SVZip ( Identification of Source Phone#:_______ Fax#: 18 •T I Collection Point i CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS . Lab#: wI ■■A Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS t_ Heterotrophic Plate Count ' (hemodialysis & all others) __ Coliform P/A (Public supplies)' __ Trihalomethanes (524) __ Volatile Halocarbons (524) __ Purgeable Halocarbons (624/8260) __ Purgeable Aromatics (624/8260) 4 .__ Coliform MPN (priv well, raw, stp) >__ Fecal Coliform (all samples) __ Volatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Acrolein & Acrylonitrile (8260) __ Organochlorine Pesticides (608/8081) u- >1 ■__ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) V I__ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) I API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SM18/6630) ■I __ Other:_____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) I __ 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) /‘j __ Diquat (549) J/GC/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) Z »_ Other:__________________________ __ Other Pesticides (SMI 8/6630) " ''' pH ___________ RADIOCHEMICAL ANALYSIS _UCMRList 1 _ MtBE Only (52'4) 1. .‘a,-/

‘ Radon _L Other____________________

1■ z / I '« JNORGANIC ANALYSIS REQUESTED - Lab#: I__ Color / ,__ Turbidity' __ Acidity __ Alkalinity Aluminum _ Antimony __ Potassium Seleniurh Z -s I i— __ Conductivity __ Bromide । __ Bromate/Chlorate/Chlorite __ Arsenic ■ Barium Silver __ Sodium .1

I__ Corrosivity (temp:. °C) __ Chloride - Beryllium _ Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium_ p'‘5 4__ 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*2 CLP _ Metals/CN 3 __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total __ Total Organic Carbon __ Volatiles ;_ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Total Organic Halides __ Semi-violatiles __ Nitrogen, Total Kjeldahl as N _ Cobalt ■._ Solids, Percent (%) __ Pesticides/PCB's __ Oil and Grease ^Copper *__ Solids, Settleable __ Phenol _ Iron TCLP __ Solids, Suspended _ Phosphorus Total as P ■■-Lead __ Solids, Total _TCLP-Metals __ Phosphorus, Ortho as P __; Magnesium '__ Solids, Total Dissolved __ TCLP-Pesticides __ Sulfates __ Manganese ¥ __ Solids, Total Volatile __ TCLP-Herbicides __ Surfactants Mercury _ Other:_________________ _ TCLP-Volatiles _ UV254 Molybdenum _ TCLP-BNA's __ Nickel

NYC-WTC_000074481