Chain of Custody Record, Westchester County Lab, Mar 2002

NYC 9/11 Public Portal Document

It* A cent ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH, 2 Dana Road, Valhalla, New York 10595 T, ; (914)231-1620 Fax (914)231-1772 NYS-ELAP No. 10108 / ' Time/Date Set; Form A-70 (rev. 10/01)

Sample Type (circle one): Y,.? V <! ■■ . ... 7 ^.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 ' .7 J Name/Company Street ' _______ Street__________ - City/St/Zip________________ City/St/Zip i- A Identification of Source Phone#:________ Fax#: Collection Point CA,CH, Bl? Check#: Amounts.

it BACTERIOLOGICAL ANALYSIS -Lab#;__________________________ Lab#: 1

ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count I: __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) i __ Coliform P/A (Public supplies) s __ 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) । 2__ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SMI 8/6630,8151) ___ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI 8/6630) l_Other: __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water R^rigerated? yes___ no _ Carbamate Pesticides -(531) _ Acid Extractables (625/8270) 'Chlorinated:'? yes___ no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) __ Diquat (549) - ; __ ___ 2_'GC/MS Unknown Scan Free Chlorine Res:. ________ mg/L __ Chlorination Disinfection Byproducts ^ (551) ' ___ Phthalates (606MS) 1 Total Chlorine Res: ________ mg/L __ Haloacetic Acids (552) t . Other:. R Mr __ Other Pesticides (SM18/6630) „ _UCMR List 1 _MtBE Only (524) J ~~ ■ " ■■

other O' £ Ii IMORGANIC ANALYSIS REQUESTED - Lab#: ftM_.Col6? ■ (-^Turbidity __ Acidify __ Alkalinity 1 jj; Aluminum _ Antimony __ Potassium Selenium __ Bromide ___ _ Arsenic Silver 1 %__ Conductivity __ Bromate/Chlorate/Chlorite Barium __ Sodium Corrosivity (temp °C) __ Chloride _^-Berylliurh __ Thallium i__ BOD (5 day) __ Cyanide __ Boron __ Vanadium y- J— Carbonaceous BOD (5 day) __ Fluoride __ Cadmium _1 Zinc J__ Soluble BOD (5 day) c- Chemical Oxygen Demand __ Hardness, Total as CaCOa __ Nitrogen, Ammonia as N __ Calcium, as CaCOs __ Calcium, Ca*2 CLP Dissolved Oxygen _ Metals/CN _ Nitrogen, Nitrate as N _Chromium, Total —1_ Total Organic Carbon -__ Nitrogen, Nitrite as N ’ __ Volatile s __ Chromium, Hexavalent '-/Ll Total Organic Halides __ Semi-vioIsJii'ies __ Nitrogen, Total Kjeldahl as N • ^Cobalt —1. Solids,.Percent (%) __ Pestic-ides/PCB’s Oil and Grease • _Copper —3 Solids, Settleable __ Phenol __ Iron ,Solids, Suspended __ ' Phosphorus Total as'P idLP __ Lead Solids, Total __ TCLP-Metals. __ Phosphorus, Ortho as P __ Magnesium f ,:-L-..,\Solids, Total Dissolved __ TCLP-Pesticides I __ Sulfates __ Manganese /—^iSolids, Total Volatile __ Surfactants, '' ‘ __ TCLP-Herbicides __ Mercury _ TCLP-\/olatiles ' Other; _______ _ UV254 __ Mdlybdenurn _ TCLP-BfJAs . __ Nickel ■ v- -.sr NYC-WTC_000074925 '