Chain of custody form, Westchester County Labs, undated

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III Ulestchester County ge/DateSet:_________ ;___________ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Form A-70 (rev. 1/96)- “ample lype (uncle one): ------ 6777 855 “2187 68:"c6r * ( 1 Potable 3. Non-Potable Treated 695z s099 ssi 8417 sA S Bottle #‘s: __________ _ 2 r _______________• 2. Non-Potable 4. Other______________ ____ Chain of Custody? yes no Time/Date Collected: 28/200/ 0443 Comments: Collected By: F, s @-SbL co 5 Agency Code: PWS #:________ Source ID: Type Descriptor:. Collected From: Bill to: Location’s/Individual’s Name. Wkallut Name/Company Street_________ _ Street_________ _ City/St/Zip Identification of Source. B& LAA# Phone#:_ Fax #:. Collection Point, 24150 29420 CA, CH, Bl?. Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:____________________ Lab#:________________ (circle tests) (circle tests) 1. Heterotrophic Plate Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 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. Microextractabies (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic 7) Pesticides/PCB screen (508) 7. Herbicides (SM-1 8/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) • Other:_____________ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) (10) Pesticides (525) 10. Glycols in Water Refrigerated? yes____ no 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 Chlorine Res:. mg/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 INORGANIC ANALYSTS REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity 20. Acidity 21. Alkalinity, as CaCOs 39. Aluminum mo * S 59. Potassium 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 I 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*2 66. Metals/CN 10. Dissolved Ofygen 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. Oli and Grease 51. Copper 70. Disk Deliverables TCLP

0 Solids, Settleable 33. Phenol 52. Iron Solids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals ) Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 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. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000026948