Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

1 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM lester I {OWVH? ’C. WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 shdld^ MYS-ELAP No. 10108 Time/Date Set? iiiui Form A-70 (rev. 10/01)

Sample Type (circle one);- 1 .Potable I3. Non Potable Treated Bottle #’s: .-i II ■I 2. Non Potable Chain of Custody? Yes No Time/Date Collected: /' . \ - ■ill Comments: Collected By; ' , ' V Agency Code: PWS #:_________ Source ID:; Type Descriptor:

Collected From: Bill to: Location’s/individual's Name .■ 3/.: Name/Company _■ Street____________________ Street; City/StfZip________________ City/St/2ip Identification of Source __ Phone#:; Fax#:^

Collection Point__________ j g II CA.CH, Bi? Check#: Amounts

BACTERIOLOGiCAl ANALYSIS Lab#: Lab#:i ORGANIC POTABi E ANALYSIS ORGANIC NONPO1ABL.E/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeabie Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, sip); __ Volatile Aromatics (524) Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine 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 (SMI8/6630) I __ 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) __ 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) pH _____ _ ______ _ UCMR List 1 RADIOCHEMICAL ANALYSIS _ MIBE Only (524) Radon ■I __ Other;

tNORGANSC ANALYSIS REQUESTED - i.nhrf: illl __ Color _ Acidity Aluminum __ Potassium

I ■I __ Turbidity pH __ Conductivity __ Alkalinity __ Bromide __ Bromate/Chlorate/Chlorife __ Antimony _ Arsenic __ Barium __ Selenium __ Silver __ Sodium __Corrosivity (temp:. “C); __ Chloride __ Beryllium __ Thallium II __ BOD (5 day) __ Cyanide __ Boron __ Vanadium Carbonaceous BOD (5 day) __ Fluoride __ Cadmium _ Zinc __ Soluble BOD (5 day) Hardness, Total as CaCOs __ Calcium, as CaCO.i P __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Metais/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N „Chromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent; __ Semi-vioiatiles Total Organic Halides __ Nitrogen, Total Kjeldahl as N Cobalt ■ __ Solids, Percent (%) ____ Solids, Settleable __ Oil and Grease __ Phenol __ Copper __ Iron __ Peslicides/PCB's

rcLP Ih __ Solids, Suspended __ Solids. Total __ Solids. Total Dissolved __ Phosphorus Total as P _ Phosphorus, Ortho as P __ Sulfates __ Lead __ Magnesium __ Manganese __,TCL P-Metals __TCLP-Pesticides! /iJiSBafiSiBlOiBlIlOI/lllllil __ TCLP-Herbicides; '__ Solids, Total Volatile __ Mercury __ TCLP-Volatiles Other:_____________ _ __ Molybdenum _ TCLP-BNAs . . ------------------ ; _ Nickel

NYC-WTC_000074507