Chain of Custody Record, Westchester County Lab, Mar 2002

NYC 9/11 Public Portal Document

) ACCn, ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ^Wfestchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 iih*- NYS-ELAP No. 10108 i Time/Date Set: Form A-70 (rev. 10/01) i- Sample Type (circle one): / I tf,1. Potable 3. Non Potable Treated Bottle #'s: ' . 2. Non Potable 4. Other Chain of Custody? Yes No Time/Date Collected; Comments: Collected By: ' ' ■ Agency Code: PWS #:________ Source ID; Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street_______________________ Street_________ City/St/Zip____________________ City/St/Zip Identification of Source Phone#:_______ Fax#: Collection Point< '' CA,CH, Bl? Check#: Amount$

BACTERIOLOGICAL ANALYSIS Lab#: I

Lab#:_________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) (hemodialysis & all others) __ Purgeable Halocarbons (624/8260) s. __ Coliforrh 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 (SMI8/6630) __ 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) _ I^GC/MS Unknown Scan Free Chlorine Res: mg/L I __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res: mg/L __ Haloacetic Acids (552) __ Other:________ _____ pH ' __ Other Pesticides (SMI8/6630) r.f- _UCMRList1 RADIOCHEMICAL ANALYSIS _MtBEOnly (524) __ Radon __ Other___________________

INORGANIC ANALYSIS REQUESTED - Lab#: i I __ Color __ Acidity ‘ __ Aluminum __ Potassium __ Turbidity __ Alkalinity Antimony jJ Selenium .t' _ pH __ Bromide JI Arsenic Silver __ Conductivity __ Bromate/Chlorate/Chlorite Ji Barium __ Sodium _ Corrosivity (temp; .‘’C) __ Chloride Beryllium Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium 1 __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium Zinc 1' _ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOa CLP “ I __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 _ Metals/CN r1 __ Dissolved Oxygen __ Nitrogen, Nitrate as N _JChromium, Total __ Volati les __ Total Organic Carbon __ Nitrogen, Nitrite as N _ Chromium, Hexavalent I __ Total Organic Halides _ _ Nitrogen, Total Kjeldahl as N __ Semi-violatiles i ' Cobalt __ Solids, Percent (%) _ Pesticides/PCB’s __ Oil and Grease Copper __ Solids, Settleable __ Phenol Ji Iron •I TCLP __ Solids, Suspended __ Phosphorus Total as P J_ Lead __ Solids, Total _TCLP-Metals Phosphorus, Ortho as P __ Magnesium __ Solids, Total Dissolved __ TCLP-Pesticides __ Sulfates ■jri. Manganese __ Solids, Total Volatile __ TCLP-Herbicides t. __ Surfactants __ Mercury _Lr'Other: J , ” _ TCLP-Volatiles _.UV254 Molybdenum _ TCLP-BNA’s _L. Nickel i I. NYC-WTC_000074701