Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

1 A !? e • ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ester WESTCHESTER COUNTY LABORATORIES AND RESEARCH & I ovcom: 2 Dana Road, Valhalla, New York 10595 it ,. NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type (circle one):^ 6, ' 1. Potable 3. Non Potable Treated Bottle #’s:______ : ■■■■I 2. Non Potable 4, Other____________: Chain of Custody? Yes No Time/Date Collected; r ■ ... - - Comments; Collected By: < Agency Code: PWS #:________ Source ID; Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street iilllillSllBIIHiSI liiit ■1 City/St/Zip City/St/Zip Identification of Source Phone#:_______ Fax#; Collection Point______________ ica^chTbi?' Check#: Amounts ■■

BACTERIOLOGICAL ANALYSIS Lab#: Lab#: ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYS S __ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform MPN (priv well, raw, stp) __ 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) __ Macroscopic __ Pesticides/PCB screen (508) __ Herbicides {SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SM18/6630) __ 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) _ fGC/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 (SMI 8/6630) pH___________ _UCMRList1 f?ADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon ■I __ Other:

INORGANIC ANAtJs'SiS REQUESTED - Lal,?: - __ Color __ Acidity LK Aluminum __ Potassium __ Turbidity __ Alkalinity Antimony __• Selenium I __ pH __ Bromide __ Arsenic . Silver __ 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 CaCOa __ Calcium, as CaCOa __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Metals/CN ^Chromium, Total __ Total Organic Carbon __ Volatiles __ Nitrogen, Nitrite as N __ Chromium, Hexavalent . .. 'rotai Organic Halides __ Semi-violatiles __ Nitrogen, Total Kjeldahl as N _ Cobalt __ Solids. Percent (%) __ Pesticides/PCB’s __ Oil and Grease J_ Copper ___ Solids, Settleable __ Pheno! __ Iron __ Solids, Suspended tclp __ Phosphorus Total as P Lead _ Solids, Total .__TCLP-Metals __ Phosphorus, Ortho as P __ Magnesium __ Solids. Total Dissolved __ TCLP-Pesticides __ Sulfates __ Manganese __ Solids, Total Volatile __ TCLP-Herbicides __ Surfactants _L. Mercury __ Other:_______ _ TCLP-Volatiles _ UV254 __ Molybdenum _ TCLP-BNAs _ i Nickel

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