Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM j-^jestcliester WESTCHESTER COUNTY LABORATORIES AND RESEARCH ■WWMSPVcom 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 '. I ■ Time/Date Set: Form A-70 (rev. 10/01) ' 3

Sample Type (circle one): - d Li. Potable 3. Non Potable Treated Bottle #’s: ------------------------ , -Y ■ 2. Non Potable 4. Other___________ Chain of Custody?Yes___ No ; Time/Date Collected: Comments:__________________ s I Collected By: > Agency Code: PWS #: Source ID: Type Descriptor:' Collected From: Bill to: Location’s/lndividual's Name Name/Company.. j Street_________________ street________ City/St/Zip______________ ■City/St/Zip y Identification of Source Phone#: Fax#: i Collection Point CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#: '3 .3* Lab#:______________ _ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count 4 (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) , __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Fecal Coliform (all samples) __ Microscopic __ Microextractables(504)" _ PCB’s (Arochlors) (608/8081) 1 __ Macroscopic , __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) '1 __ 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) i__ GC/MS Unknown Scan Free Chlorine Res:_ mg/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) Total Chlorine Res:; mg/L __ Haloacetic Acids (552) __ Other:_____________ __ Other Pesticides (SMI8/6630) '-i I pH __ UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBE Only (524) __ Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#: f A-''" __ Color __ 4cidity iJL Aluminum __ Potassium __ Turbidity __ Alkalinity i_ Antimony J_ Selenium j ' ' _ pH __ Bromide- ___ Arsenic _ Silver i V. __ Conductivity __ Bromate/Chlorate/Chlorite ,__ Barium __ Sodium ■ f. __ Corrosivity (temp:. °C) __ Chloride :_ Beryllium Thallium I _ BOD (5 day) __ Cyanide __ Boron __ Vanadium ' __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium Zinc t _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOa CLF ' I __ 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 tJ __ Solids, Suspended TCLP 5’ __ Phosphorus Total as P __ Lead 1 _TCLP-Metals ' __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides ■__ Solids, Total Dissolved __ Sulfates _i_ Manganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants _ Mercury _ TCLP-Volatiles Other: _____________ _ UV254 __ Molybdenum I __ TCLP-BNA's __ Nickel

NYC-WTC_000074484