Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document z: ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

ft WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 /I

NYS-ELAP No. 10108 X

Time/Date Set: Z' Form A-70 (rev.10/01)

Sarnple Type (circle one):

CjL Potable.- 3. Non Potable Treated Bottle #’s:

I h' 2. Non Potable Time/Date Collected: 4. Other_____________ Chain of Custody?___ Yes Comments:_____________________ No f ■

Collected By: '. Agency Code: PWS #: Source ID: Type Descriptor: Collected From: Bill to:

I- Location's/lndividual’s Name Street City/St/Zip i Name/Company Street_________ City/St/Zip Phone#: Fax#: K' Identification of Source f

f Collection Point______ : CA,CH, Bl? Check#: Amounts

bacteriological analysis Lab#: Lab#:_________________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) ■t (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) __ Microscopic __ Macroscopic __ Total Trihalomethane Potential (510) __ Microextractables (504) __ Pesticides/PCB screen (508) __ Organochlorine Pesticides (608/8081) _ PCB’s (Arochlors) (608/8081) _ Herbicides (SM18/6630,8151) __ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI 8/6630) ‘__ 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) ISGC/MS Unknown Scan J

I Free Chlorine Res: Total Chlorine Res: . mg/L mg/L __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) _ Phthalates (606MS) __ Other:________________________________ __ Other Pesticides (SM18/6630) pH _____________ _UCIVlR List 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) ___ Radon

k __ Other __ _____________________

INORGANIC ANALYSIS REQUESTED - Lab#: . - / r / __ ’Color __ Acidity .-Aluminum __ Potassium

I __ Turbidity _ pH __ Alkalinity __ Bromide < Antimony .. Arsenic Selenium __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite _ Barium __ Sodium __ Corrosivity (temp:. °C) __ Chloride Beryllium _ •_ Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride _jL'Cadmium __Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N j^Chromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles

r __ Total Organic Halides __ Solids, Percent (%) __ Solids, Settleable __ Nitrogen, Total Kjeldahl as N __ Oil and Grease __ Phenol Cobalt _Copper Iron __ Pesticides/PCB’s

TCLP __ Solids, Suspended __ Phosphorus Total as P jl>Lead _TCLP-Metals ' Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides

L Si __ Solids, Total Dissolved __ Solids, Total Volatile Other:_______ ____________ __ Sulfates __ Surfactants _ UV254 __ Manganese Mercury Molybdenum /’■Nickel __ TCLP-Herbicides _ TCLP-Volatiles _ TCLP-BNA's 1 f Lj2------ = - NYC-WTC_0000‘74528