Chain of Custody Record, Westchester County Lab, Mar 2002

NYC 9/11 Public Portal Document

I \!» ACCo ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 1 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 ^'1 1 A NYS-ELAP No. 10108 I Time/Date Set: Form A-70 (rev.10/01) s

Sample Type (circle one): 1 . Potable 3. Non Potable Treated Bottle #’s: 4'

b - Time/Date Non Potable 4. Other Collected:________ • ■ / Chain of Custody? Comments: Yes No

Collected By: / ' 'r t 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#:_______ 1 Fax#: Collection Point i- CA,CH. Bl? Check#: Amounts, ■ .;s Sa.

BACTERIOLOGICAL ANALYSIS Lab#: a- 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) _ : 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) ■ __ Microextractables (504) _ PCB’s (Arochlors)’ (608/8081) __ Microscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) F __ Macroscopic _ API __ Other:_____________________ __ PCB as Decachlorobiphenyl (508A) __ Herbicides (515) __ Other Pesticides (SMI8/6630) __ 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) _f GC/MS Unknown Scan Free Chlorine Res: mg/L r Total Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) Other Pesticides (SMI8/6630) __ Phthalates (606MS) __ Other:____________________________ pH __________ _UCMR List 1 • RADIOCHEMICAL ANALYSIS __ MtBE Only (524) ^Radon

eR. _ Other 1 L

INORGANIC ANALYSIS REQUESTED - Lab#: '■7 ■

__ Color __ Acidity Aluminum * Potassium __ Turbidity __ Alkalinity __ Antimony __ Selenium r ■ _ pH __ Bromide __ Arsenic __ Silver La __ Conductivity __ Bromate/Chlorate/Chlorite“^ __ Barium '_ Sodium _ Corrosivity (temp:. °C) __ Chloride __ Beryllium J__ Thallium

t' _ BOD (5 day) __ Carbonaceous BOD (5 day) _ Soluble BOD (5 day) __ Cyanide __ Fluoride __ Hardness, Total as CaCOa __ Boron __ Cadmium __ Calcium, as CaCOa' __ Vanadium __ Zinc "CLP __ Chemical Oxygen Demand __ Nitrogen, Arhmonia as N __ Ca!cium.Ca*2 _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N .___Chromium, 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 f CLP-Pesticides __ Solids, Total Dissolved __ Sulfates __ Manganese

i __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants __ Mercury _ TCLP-Volatiles Other:_________________ _ UV254 __ Molybdenum _ TCLP-BNA's _ Nickel

NYC-WTC_000074931