Chain of custody record, Jan 2002

NYC 9/11 Public Portal Document BIB lilisaiOliiiiiBiBlfiilllllillfiBiliiiijilliOM

IM ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM sU'r WESTCHESTER COUNTY LABORATORIES AND RESEARCH /Z f f nil \;COm 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 ■« ESS NYS-ELAP No. 10108 x

Time/Date Set; Zbze P-26Z7 Form A-70 (riw. 10/01)

Sample Type (circle one): (j^otable 3. Non Potable Treated Bottle #'s:C2i3£/£Lt6L£jmiJ^ t/ 2. Non Potable 4. Other Chain of Custody?Yes ___ No t< Time/Date Collected: 6? Yg Comments; ... Collected By: a f Agency Code: PWS #;______ ___Source ID:Type Descriptor: Collected From: Bin to: Location’s/lndividual's Name T 7'5 P P Name/Company Street ; ISIStOlilSiiiii City/SVZip City/StfZip Identification of Source_____________ ,_________ Fax#;- Collection Point _____ —________ _ CA.CH, Bl? Check#; Amounts____ :

BACTERIOLOGICAL ANALYSIS Lab#; illlillllllillllO ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE:/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & all others) _ Purgeable Halocarbons (624/8260) J^jolatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _iBVolatiie Aromatics (524) __ Acrolein & Acrylonitrile (8260) ■ : __ Fecal Coliform (all samples) __ Total Trihaiomethane Potential (510) „ Organochlorine Pesticides (608/8081) P^is (Arochlors) (GOO/BOtH) __ Microscopic __ Microextractables (504) __ Macroscopic Posticidcs/PCP sf-rs'i'n (506) liorbrudcs (SMuVl....W!1M) „ API __ PCB as Decachlorobiphenyl (508A) Oto.s Poslkid.!!. iSMlK/imo) __ Other;_____________________ llfrtiioidos (515) i’r'i:,:Hu;ii tlvur.,: iinnn Smii (410-13• Pesticides (525) Refrigerated?yes; no __ Carbamate Pesticides (531) ...... Acid Extractabies (625/8270) Chlorinated;?yes no Glyphosate (547) . Base Neutral Extractabies (625/8270) __ Diquat (549) _lzfec/MS Unknown Scan ’; Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) Total Chlorine Res: iBiil __ Haloacetic Acids (552) Other;____________________________ __ Other Pesticides (SM18/6630) _________________________________________________________________________________________________________________ ______ ■

pu......... _ UCMR List 1 RADiOCHEMiCAL ANALYSIS __ MtBE Only (524) Radon

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color Turbidity __ Acidity __ Alkalinity ■ ___ Aluminum ।/Antimony _ Selenium 7 7 __ pH __ Bromide __ Arsenic ___. Silver . • __ Conductivity __ Bromate/Chiorate/Chiorite ___ Barium __ Sodium ; Corrosivity (temp;®C) __ Chloride j,z^eryllium jL/thallium : _ BOD (5 day) __ Cyanide __ Boron __ Vanadium- __ Carbonaceous BOD (5 day) __ Fluoride ___ Cadmium _ Soluble BOD (5 day) __ Hardness, Total as CaCOa ___Calcium, as CaCOa ■I -- _____________ __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N ___ Calcium, Ca« '”^"7 __ Dissolved Oxygen __ Nitrogen, Nitrate as N ___ Chromium, Total ZvoVtis __ Total Organic Carbon __ Nitrogen. Nitrite as N __ Chromium, Hexavalent : fotai Organic ilalidi?;: ■ ■■ Solids, Percom (%) .. Nitrogen, lotal Kieirfuhl ns N .M «■!,.«.««, ..tobnil ’..‘copper SsSSISbs Solids, Scltipuhi.- .. .. Solids, Suspended . . I’nosphuUis lots,: os I ... Lead I ... Sonas, lot,,! __ Solids, Total Dissolved __ Phosphorus, Ortho as P Sulfates Magnesium I^Manganese I _ Bonds, Total Volatile her:____ _____________ 77 SurfucLr.te Mon^rv I B — ____ ____ ___ __________________________ -.......... . ..... J

NYC-WTC_000073040