Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ACCo„ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH )\x:oni 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 o IJLslua Bl i.

NYS-ELAP No. 1C108 Time/Date Set: Form A-70 (rev.10/01)

Sample Type (circle one): 1. Potable :3. Non Potable Treated Bottle #'s; 2* Non Potable ilBlillllllllBBIIII Chain of Custody?: Yes No:

Time/Date Collected:: Comments; i Collected By:______ i Agency Code: 1 ' ■ h,\ PWS #:_________ Source ID: Type Descriptor:

Collected From: Bill to: Location's/lndividual’s Name I mill Name/Company

Street____________________ : Street

City/St/Zip________________ : City/St/Zip

identification of Source Phone#:________ i Fax#:

Collection Point___________ : II CA.CH, Bl? Check#: Amounts:

BACTERIOLOGICAL ANALYSIS Lab#:: Lab#:_____________________ : ORGANIC POIABLE ANALYSIS ORGANIC NONPOIABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) _ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Volatile Aromatics (524) Acrolein & Acrylonitrile (8260) __ Coliform MPN (priv well, raw. stp) __ Total Trihalomethane Potential (510) Organochlorine Pesticides (608/8081) __ Fecal Coliform (all samples) __ Microextractabies (504) PCB's (Arochlors) (608/8081) __ Microscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) __ Macroscopic PCB as Decachlorobiphenyl (508A) Other Pesticides (SMi8/6630) __ API __ 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) _2. GC/MS Unknown Scan Free Chlorine Res;: . mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:___ . . mg/L Haioacetic Acids (552) Other:_______________________________ __ Other Pesticides (SM18/6630) pH _____________ _UCMRList1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) ___ Radon _ Other 5== INORGANIC ANALYSIS REQUESTED - __ Color __ Acidity __ Aluminum __ Potassium ■I __ _ Turbidity __ Alkalinity __ Antimony II pH __ Bromide __ Arsenic __ Selenium __ Silver

fl 111 __ Conductivity __ Corrosivity (temp:. .’C): __ Bromate/Chlorate/Chlorite __ Chloride __ Barium __ Beryllium __ Sodium _ Thallium

■ ■I _ BOD (5 day) _ Carbonaceous BOD (5 day) _ Soluble BOD (5 day) __ Cyanide _ Fluoride __ Hardness, Total as CaCOs __ Boron __ Cadmium __ Calcium, as CaCO;! __ Vanadium __ Zinc

__ _ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium. Ca+2 _ Metais/CN ■I __ 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

1 Solids, Percent (%) __ Solids, Settleable Solids, Suspended _ Oil and Grease __ Phenol __ Phosphorus Total as P __ Copper __ Iron __ Lead (CLP _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium TCLP-Pesticides __ Solids. Total Dissolved __ Sulfates __ Manganese _TCLP-Herbicides __ Solids, Total Volatile __ Surfactants _ Mercury __ TCLP-Volatiles __ Other:___________________ : __ Molybdenum TCLP-BNA's __ Nickel

NYC-WTC_000074502