Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ACCo ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 2Ster DVATMll: WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 4 oj a A. NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01) )

Sample Type (circle one); Bottle #’s:

2. Non Potable 4. Other : Chain of Custody?: Yfis No Time/Date Collected: ____ Comments:. Collected By;_____________ _ Agency Code: PWS #:: Source ID:: Type Descriptor: Collected From; Bill to;

Location's/lndividual’s Name : 4 Name/Company Street____________________ Street: City/St/Zip________________ City/SVZip i Identification of Source _ Phone#:i Fax#:- II Collection Point___________ ; rCACHTBI? Check#:: Amounts.

bacteriological ANALYSIS Lab#: Lab#:1 IS ORGANIC POTABLE ANALYSIS ORGANIC NONPO5ABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) Purgeable Halocarbons (624/8260) (hemodialysis & ali 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) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) Organochiorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) __ PCB's (Arochlors) (608/8081) __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8151) __ Macroscopic __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) Oil API................................................... __ Other:I __Herbicides (515) ; Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) Acid Extractabies (625/8270) Chlorinated:? yes no __ Glyphosate (547) Base Neutral Extractabies (625/8270) Diquat (549) __ GC/MS Unknown Scan Free Chlorine Res;: - rng/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS)i ■I Total Chlorine Res; . mg/L __ Haloacetic Acids (552) „Other Pesticides (SMI8/6630) Other;:

pH_____________ 111 _UCMRList1

1/ ! RADIOCHEMICAL ANALYSIS ___ Radon __ Other: _ MtBE Only (524)

liiiiii iNORGANiC ANALYSIS REQUESTED - ; .tt:.: _•

I All __ Color __ Turbiditv pH _ Conductivity __ Acidity __ Alkalinity __ Bromide 111(111

__ Bromate/Chlorate/Chlorite __ Aluminum ___ Antimony __ Arsenic __ Barium __ Potassium __ Selenium Silver __ Sodium __ Corrosivity (temp:: “C) __ Chloride __ Beryllium __ Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium g- Carbonaceous BOD (5 day) ___ Soluble BOD (5 day) __ Fluoride __ Hardness, Total as CaCOa __ Cadmium __ Zinc __ Calcium, as CaCOs CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium. Total 'L Metals/CN __ Volatiles __ Total. Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles

I __ Total Organic Halides __ Nitrogen, Total Kieidahi as N __ Cobalt __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease __ Copper __ Solids, Settleable __ Phenol __ Iron TQl-P __ Solids, Suspended __ Phosphorus Total as P __ Lead _._TCLP-Metais ill _ Solids, Total __ Solids, Total Dissolved __ Phosphorus, Ortho as P ' __ Sulfates __ Magnesium __ Manganese __ TCLP-Pesticides TCLP-Herbicides __ Solids. Total Volatile __ Surfactants __ Mercury TCL P-Volatiles _ Other:: IliilliSSIIliiilliiliM _ Moiytxlenum _ TCLP-BNAs __ Nickel

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