Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document s AA" -,7"‘4 "WD -T ■

UI ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM / WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 * Itae/DateSet__________________________ ______ _ Form A-70 (rev. 1/96) Sample Type (circle one): Z A - i i •- ? J 1 Potable 3. Non-Potable Treated Bottle #‘s: 734* -• s I J 6 /73 i 4 t

2. Non-Potable 4. Other______________________ - Chain of Custody? yes no Time/Date Collected: Je t ____ __ _ Comments: Collected By: DSAckem Agency Code: . PWS#:__________ .Source ID:. Type Descriptor: Collected From: Bill to: Location’s/Individual’s Name. CS _ Name/Company Strpet______________ ___ Street___________ _ _ Identification of Source___ p4P # Phone#:, Fax#: Collection Point. 4350 30149/. . I CA, CH. Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: (circle tests) ' 1. Heterotrophic Plate : L.—.—224/V6— 1. Trihalomethanes (524) (2. Volatile Halocarbons (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 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. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic 0 Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API . 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) &afther: _____________ . . 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. = -Xi . 25, INORGANIC ANALYSES REQUESTED "Lab#:___________ (circle test) 10.4 i /I aks 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. T urbidity 21. Alkalinity, as CaCO3 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: °C) 24 Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc__________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 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 51. Copper 70. Disk Deliverables 14Solids, Settleable 33. Phenol 52. Iron TCLP Nolids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. 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. UIV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel - ------ - AAL NYC-WTC_000027358