Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH I?* 2 Dana Road, Valhalla, New York 10595 o/ll o/ I I

.E Time/Date Set; (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Form A-70 (rev. 10/01)

I Sample Type (circle one): ^i.Potable,.^ 2. Non Potable 3. Non Potable Treated

Time/Date Collected: 4. Other .. & AX Bottle #'s: Chain of Custody?Yes Comments:___________________ No I ■ /

Collected By: L 4 'T' Agency Code: PWS #: Source ID: Type Descriptor: Collected From: Bill to: Location's/lndividual’s Name Name/Company fs Street Street_______

f City/St/Zip Identification of Source City/St/Zip Phone#: Fax#: Collection Point I CA,CH, Bl? Check#: Amounts.

t BACTERIOLOGICAL ANALYSIS Lab#:_______________________ Lab#:

ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260)

r __ 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) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) __ PCB's (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SMI8/6630) J"I _ API __ Other:_____________________ __ Herbicides (515) __ Pesticides (525) __ Petroleum Hydrocarbon Scan (310-13) __ Glycols in Water ' Refrigerated? yes___ no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) Chlorinated:? yes___ no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) K5 __ 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 (SM18/6630) pH Mi __ UCMR List 1 RADIOCHEMICAL ANALYSIS __ MtBE Only (524) ___ Radon _ Other____________________ V . / INORGANIC ANALYSIS REQUESTED - Lab#; __ Color __ Acidity Aluminum __ Potassium __ Turbidity __ Alkalinity >2, Antimony ^Selenium _ pH __ Bromide Arsenic _>LSilver __ Conductivity __ Bromate/Chiorate/Chlorite >£ Barium __ Sodium __ Corrosivity (temp:. .°C) __ Chloride Beryllium _::Thallium' __ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride 2:i.Cadmium _/-Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs CL^ __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca-^’ __ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N _2Chromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Cobalt __ Pesticides/PCB's __ Solids, Percent (%) __ Oil and Grease __ ^.Copper __ Solids, Settleable __ Phenol Iron TCLP __ Solids, Suspended __ Phosphorus Total as P Lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates __ Manganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants __ Mercury _ TCLP-Volatiles I _£ Other; _ UV254 Molybdenum _ TCLP-BNA's Nickel

NYC-WTC_000074530 '