Chain of custody form, Westchester County Lab, Sep 2001

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JL gge/DateSet:____ it WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575i NYS-ELAP No. 10108 Form A-70 (rev. 1/96) “Sample Type (circle one): &0I,FB0,2516,8622 PFB 8-78, 2632 otable 3. Non-Potable Treated Bottle #s:80 20s " OVo 3 &o‘s 2,0036 2. Non-Potable 4. Other . _____ _______ _ Chain of Custody? yes .no Time/Date Collected: 9122/2001 I An_____ Comments: Collected By: M-YACoUp— Agency Code:______ _ _ Source ID:. Type Descriptor: Collected From: 5 . ♦ .. Bill to: Location’s/individuarsName HHve ew IO see VO / r Name/Company Street_____ ___________________ -_____ _ ______ Street_____ ___ 1* City/StZip 12 ■. ________ — Chv/SUZio Identification of Source:.___ _____ -t—— Phone#: .Fax #: — . Collection Point-. 55 6153 CA, CH, BI?- Check#: Amounts, 1 50080-4 ssi BACTERIOLOGICAL MALYSFSg Lab#: , ' -rle . ' ia e 282.2,2210 ORGANIC POTABLE "ANALYSES ~ ORGANIC NONPOTABLE/SOLID ANALYSES

(circle tests) - — 1.HeterotrophicreSrSit (circle tests).

Count (hemodlalysis & all others) ! 1. Trihalomethanes(524) 2.7 Volatile Halocarbons (524) 1 1. Purgeable Halocarbons (624/8260) 2. Purgeable Aromatics (624/8260) 2. Coliform PIA (publc supplies). . 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN priv well, raw, stp) 4.. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic pan 6. Pesticides (507) . 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic-: it ) : C C.Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. PCB as Decachlorobiphenyl (508A) S— ' . ( 10. Pesticides (525) 7. API .ti . 9.Herbicides (515) 8. Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) | 10. Glycols in Water 4 Refrigerated? . yes ’ hoi 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: yes no 13. Diquat (549) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chionne Res:, —ma/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: _mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

pH. A INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity * 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: 6. BOD (5 day) °c) 24. Chloride 25. Cyanide 43. Beryllium 44. Boron 63. Thallium 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc_________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCO3 CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*2 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease a 51. Copper 70. Disk Deliverables 14Solids, Settleable 33. Phenol 52..Iron TCLP Colids, Suspended 34. Phosphorus. Total as P 5^|Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pestlcides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other: ______ _________ 38. WV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel ——------ Ms-ctt __===== ====. NYC-WTC_000026441