Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document I I

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 <>/■ 1 (914)231-1620 Fax (914) 231-1772 i NYS-ELAP No. 10108 Jime/Date Set;

Sample Type (circle one): <•1 7"A > 7 t Form A-70 (rev.10/01)

-'•) I h. Potable' 3. Non Potable Treated Bottle ‘#’s: 12. Non Potable 4. Other _ __________ Chain of Custody?___ Yes No '^Time/Date Collected: j;____ Comments: J Collected By;___________ , , Collected From: Agency Code: PWS #:______ Bill 4o; Source ID; Type Descriptor; 'I ' Location's/lndividuars Name Name/Company Street_________________ Street ________ I City/St/Zip____________ ; Identification of Source City/St/Zip Phone#: Fax#; 1 I Collection Point CA,CH, Bl? Check#; Amounts

^BACTERIOLOGICAL ANALYSIS Lab#; / - ■Lab#:_______________________ *__ Heterotrophic Plate Count ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Trihalomethanes (524) __ Purgeable Halocarbons -(624/8260) ; (hemodialysis &'all others) __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624?826o) ,■ J I__ Coliform' MPN (priv well, raw, stp) __ Volatile Aromatics (524).,,- _ Acrolein & Acrylonitrile (8260)' ./ __ Fecal Coliform (all samples) __ Microscopic _ /'Total Trihalomethan'e Potential (510) __ Microextractables (504) __ Organochlorine Pesticides (608^081) _ PCB’s (Arochlors) (608/8081) /S __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) .'it _ API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SM18/6630) f/ __ Other:■ _ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water I Refrigerated?yes no __ Carbamate Pesticides (531) __ Acid Extractables (625/8270) I

Chlorinated:? yes no __ Glyphosate (547) __ .Base Neutral Extractables (625/8270) _ Diquat (549) GC/MS Unknown Scan Free Chlorine Res:. . mg/L .__ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) I

Total-Chlorine Res:___ - mg/L _ Haloacetic Acids (552) ■ ’ __ Other:___________ - pH<t_______ ■ ■} __ Other Pesticides (SM18/6630) % _UCMRList1 ; ' ! RADIOCHEMICAL ANALYSIS _ MtBE Only (524) i__ Radon I __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#; , ■ ) ’ V- b __ Color __ Acidity Aluminum __ Potassium __ Turbidity __ Alkalinity _ Antimony __ Selenium _ pH __ Bromide ■__ Arsenic Silver I i- __ 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 t __ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand CLP __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Dissolved Oxygen __ Metals/CN __ Nitrogen, Nitrate as N _lChromium, 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 ■r __ Oil and Grease Copper __ Solids, Settleable __ Phenol _ Iron TCLP .__ Solids, Suspended __ Phosphorus Total as P __ Lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ . Solids, Total Dissolved __ TCLP-Pesticides __ Sulfates __ Manganese __ Solids, Total Volatile __ TCLP-Herbicides __ Surfactants __ Mercury ’r;:' Other: _ TCLP-Volatiles _ UV254 ’ __ Molybdenum _ TCLP-BNA’s __ Nickel -------- ------------------------ NYC-WTC_000074482