Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

l« ACO-j. ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH ■ >\:coni 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set? Form A-70 (rev. 10/01)

Sample Type (circle one): 111 ■■l 1. Potable 3. Non Potable Treated Bottle #'s:____________________ j Illi ■ 2. Non Potable OlBBSililllsBlIlilB Chrsin of Custody?___ Yes No Time/Date Collected: ISIIIs Comments:. Collected By: i J _x_ Agency Code? PWS #;: Source ID:: Tvpe Descriptor: Collected From: Bill to: Location's/lndividual’s Name '0^ Name/Company _ Street: Street: City/St/2ip....... .................................... City/St/2ip: Identification of Source Phone#:: Fax#:^ Collection Point___________ ' ■ "■ CA,CH, Bl?: Check#;^ Amounts II BACTERIOLOGICAl ANALYSIS Lab#: Lab#:: ORGANIC POTABLE ANALYSIS ORGANIC NONPO1ABLE/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) __ Coliform MPN (priv well, raw, stp): __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) ■I __ Fecal Coliform (all samples) _ Total Trihalomethane Potential (510) __ Microextractables (504) __Organochiorine Pesticides (608/8081) __ RGB's (Arochlors) (608/8081) _ Microscopic __ Macroscopic __ Pesticides/PCB screen (508) ...... Herbicides (SM18/6630,8151) __ PCB as Decachlorobiphenyl (508A) __Other Pesticides (SMI8/6630) i __ API __ Other: ___ _____________ _ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) I Refrigerated?yes no __ Pesticides (525) __ Carbamate Pesticides (531) __ Giycois in Water _ Acid Extractables (625/8270) Chlorinated:? yes no _ Glyphosate (547) __ Base Neutral Extractables (625/8270) _ Diquat (549) __ GC/MS Unknown Scan jl|B Free Chlorine Res:: .mg/L __ Chlorination Disinfection Byproducts (55 >) __ Phthalates (606MS) Total Chlorine Res: - mg/L: __ Haloacetic Acids (552) „ Other;_____ _______________ _ Other Pesticides (SMI8/6630) ■I pH _ _UCMRList1 RAOiOCHEP0ICAi. ANALYSIS __ MtBE Only (524) ■I __ Radon hiiiii __ Other_____________________ O !■ INORGANIC analysis REQUESTED ■ . __ Color __ Acidity B __ Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony __r Seienium _ pH __ Bromide _ : Arsenic .■Silver ill __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 _ Soluble BOD (5 day) __ Hardness. Total as CaCO:3 __ Calcium, as CaCO? Che.mica! 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 ■II __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Cobalt __ Semi-vioiatiles __ Pesticides/PCB's m __ Solids. Percent (%) __ Oil and Grease __ Copper _ Solids, Settleable _ Phenol __Iron TCLP _ Solids, Suspended __ Phosphorus Total as P _ Lead __TCLP-MGtais _ 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 jZ Nickel

NYC-WTC_000074503