Chain of Custody Record, Westchester County Lab, Mar 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH h' 2 Dana Road, Valhalla, New York 10595 I/' I Time/Date Set: (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 FormA-7O(r0v.1O/O1)

i Sample Type (circle one): 1, Potable 3. Non Potable Treated Bottlers: 2. Non Potable 4. Other . /___________ Chain of Custody?__ _ Yes___ No Time/Date Collected: Comments: Collected By: • /b ' Agency Code: i PWS#:_ Source ID; Type Descriptor

I Collected From: Bill to:

I ■/Street _____________________ yC^r/SWZlp __________________ Name/Company Street caty/St/ZIp -

tfWeitffication of Source Phone#: IttoSedfon Point ______________ pJACH. Bl? Amounts. ■■ - Y.- '$1 BACTERIOLOQICAL ANALYSIS Lab#; ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLIDANAlYSiS __ Heterotrophic Plate Count _Trlhatomethanes (524) ■O'PuiSbiable:Hal®Jdhs^W^^ y 1 (hemodiaiysls & all others) Coliform P/A (Public supplies) __ Volatllo Halocarbons (524) __ Purgeable Aromafics. (824/8280) __ Co!iform MPN (priv well, raw, stp) _ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) 4, Conform (all samples) _ Total Trihalomethane Potential (510) — Org^rfohkxtne Pesteides(608/8081) ; te if^'SitldiFparopfcV’'■ Macroscopic _ Microextractab)es(504) __Pestlcide8/PCB screen (508) ; PCB as Decachlorobiphenyi (508A) _ Herbicides (SM18/8630,8151) — Oth8rPestlcides(SM18/6630) , „APi -y.

i _ Herbicides (515) _ Pesticides (525) _Carbamate Pesticidos (531) E~zxr‘i _ Glyphosate (547) Base Neutral ExtractaWes (625/8270) „ ....(549) - Diquat Free Chlorine Rea: mg/L —Chlorination Disinfection Byproducts (551) L. Phthalates (606MS) ,_HaIoacetic'Acid8 (552). - I'* . Total Chlorihe Res: ______ mg/L —Other Pesticides (SM18/6630) - X . /, ,________ < X/X if- k y. - RADIOCHEMICAL ANALYSiF^ __Radon ^ucmrw 1 .• f _MtBEOnly(524) -'ZZZZiZZZIZZZZS’'^ 'ZZZZZZZZZZZZZZZZZZZZZZS -f —Other _________

INORGANIC ANALYSIS REQUESTED - Lab#: _____ ®^dol^-=?" 1 _Acldity _ .Aluminum . Potessium J "_;n»bMlly ............ -.Alkalinity _ Antimony • pH *’ ' __Conductivlty _BRwtade y _ Bromate/Chlorate/Chlorlte ^AnOc ' _ Barium •5^ __ CofTOsivlty (temp:i_i__?C) :_^-<Wide ■■ ■ _BeryHium „BOD(5day) .^iCy^ikle ^BottMt. ■ i.L^ Carbon£K»oUB BOD (5 day) _L; FiwwWo Cadmium a-'W’.... „SoIubleBOD(5 day) _ Hardness, Total as CaCOa _Caicium, as CaCO; .__ChemicatOxy9enDemand __ Nltrogen,Ammonla as N _ Calcium, Ca*2 ? M __ DlssolvedO^VSen __ NIfrogen, Nitrate as N __Chromium, Total __ Total Organic Carbon __W)gen,NlfrlteasN _ Chromium, Hexavalent _Ser^-violatiles Total Organic Halides Nitrogen, Total Kjeldahl as N _ Cobalt rp-' __ SoRds.Percent (%) __ O1I and Grease .^Ct^r _iPestfcltfes/PCB^ _ Solids, Settlsabie „ Phenol _ Iron TCLP __Solids,Su8pended „ Phosphorus Total as P _Leed __Sol}cte, Totoi _ Phosphorus, Ortho as P LiTCtP-Melals <■ _ Magnesium __TCLP-Pes8cldes Solids, Total Dissolved __ Sulfates _Mangan88e __ Sol1ds, Total Volatile __TCLP-Herbicide8 __ Surfactants __ Mercury _TCLP-Volatiles Other; ________ UV254 _Mt^fedBrKan __TClFeNAs _ Nickel ir''-

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