Chain of custody record for DEP samples, February 2002

NYC 9/11 Public Portal Document •V — jur-’- —

VI, *'^Cn ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM tester novcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 4 o//■ ■

NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type (circle one): i^^^J^otable 3. Non Potable Treated Bottle #’s: - 2. Non Potable 4. Othw 1 \ > Chain of Custody? Yes No Time/Date Collected: k ‘ 01/’ C Comments: Collected By: ( Agency Code: PWS #:________ Source ID; Type Descriptor: Collected From: Bill to: Location’s/individual’s Name Name/Company _ Street_________________ Street_________ City/St/Zip______________ City/St/Zip Identification of Source Phone#;_______ Fax#: Collection Point I CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NON POTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SMI8/6630) __ Other:_____________________ _ Herbicides (515) __ 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) __ B^e Neutral Extractables (625/8270) __ Diquat (549) .Yt-GC/MS Unknown Scan Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ Other:____________________________ A _ Other Pesticides (SMI8/6630) pH ___________ _UCMR Listi RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon __ Other____________________ / INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity • Aluminum __ Potassium __ Turbidity __ Alkalinity '^Antimony -Selenium _ pH __ Bromide enic jrT^ilver __ Conductivity __ Bromate/Chlorate/Chlorite __ Sodium __ Corrosivity (temp;. ’C) __ Chloride kx^ryllium Jr^Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium _l-;-Zfnc _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOa __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N -Calcium, Ca*^ £LE _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N '^^TChromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N _ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N J-rC'obalt __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease jvfCopper __ Solids, Settleable __ Phenol __ Solids, Suspended __ Phosphorus Total as P ICkE __ Lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ J^gnesium __ Solids, Total Dissolved 2:::^anganese __ TCLP-Pesticides __ Sulfates J:^Mercury __ TCLP-Herbicides __ Solids, Total __ Surfactants 2_^-Other:T V--------- __ TCLP-Volatiles _ UV254 2±rK4olybdenum _ TCLP-BNA's ±rlQickel

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