Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

I ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM I; WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 ■ ' NYS-ELAP No. 10108 i Time/Date Set: PV.. 2 ? 240 I Form A-70 (rev.10/01)

Sample Type (circle one): 4' OG 2'74 (l) Potable Bottle #’s: 2 "02 B' H f 6 2Sb i/:’ •2? iY 3. Non Potable Treated

I 2. Non Potable Time/Date Collected: 4. Other__________ _ Chain of Custody? Comments: Yes No

i Collected By: Collected From: J

Location’s/lndividual’s Name street pT iXb ~ / / , ' ■ k<'r' Agency Code:

br t c c PWS #:________ Bill to: Name/Company Source ID: Type Descriptor:

Street_________ City/St/Zip City/St/Zip ■ Identification of Source____________________ Phone#:_______ Fax#: Collection Point ____________ CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#:

I Lab#:_______________________ __ Heterotrophic Plate Count ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS

I h’- (hemodialysis & all others) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Tjjhalomethanes (524) ii^VpIatile Halocarbons (524) 2=<':7olatile Aromatics (524) Purgeable Halocarbons (624/8260) __ Purgeable Aromatics (624/8260) __ Acrolein & Acrylonitrile (8260)

rl st __ 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 (SMI8/6630) __ Other:_____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water

K Refrigerated?yes___ no __ Carbamate Pesticides (531) __ Acid Extractables (625/8270)

s Chlorinated:? yes___ no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) __ Diquat (549) r^GC/MS Unkno\A/n 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) I pH ___________ _UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBEOnly (524) __ Radon iK __ Other____________________ I? INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity _:^Kluminum __ Potassium __ Turbidity __ Alkalinity Antimony _i:"Selenium

/I _ pH __ Conductivity __ Corrosivity (temp:. .’C) __ Bromide __ Bromate/Chlorate/Chlorite __ Chloride ■xArsenic .x^Barium ■xBervllium _ir'Silver __ Sodium _^Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride j^'dadmium - "'Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOa 4 __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ CLP _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N _YChromium, Total __ Total Organic Carbon __ Volatiles __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Semi-violatiles _,.rCobalt

4 __ Solids, Percent (%) __ Solids, Settleable __ Solids, Suspended __ Oil and Grease __ Phenol __ Phosphorus Total as P -•'dopper _<^ron ^'Lead __ Pesticides/PCB’s

TCLP r

__ Solids, Total __ TCLP-Metals __ Phosphorus, Ortho as P __ Magnesium __ Solids, Total Dissolved ‘-f^naanese __ TCLP-Pesticides __ Sulfates »_ .Solids, Total Volatile __ TCLP-Herbicides __ Surfactants '"Mercury Other: __________ _ UV254 __ TCLP-Volatiles Molybdenum _ TCLP-BNA’s

b4 NYC-WTC2600b74529 _ ‘-Nickel