Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document V * * • '

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM "^ - x* WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla. New York 10595 (914)231-1620 Fax (914) 231-1772 NYS-ELAP NO.-10108 Time/Date Set: Eqrm A-70 (rev. 1 p/o 1)

Sample Type (circle one): e- Fr 7 Csi PoteblJ^ 3. Non Potable Treated BSttle #’s: " ' 2. Non Potable 4. Other________ Chain of Custody? Yes No Time/Date Collected: Comments: J Collected By: t-r f c. ‘O Agency Code: PWS #:________ Source ID: .Type Descriptor: Collected From: Bill to: Location’s/lndividual's Name Name/Company _ Street /.,<Y Street_________ City/St/Zip________________ City/St/Zip_____ Identification of Source Phone#:_______ Fax#: Collection Point fV f / I CA,CH. Bl? Check#: Amourit$.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/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) __ Organdchlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) ■ _'PCB’S (Arochlors):(6p8/8081) ' __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SMI 8/6630.8151) _ 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) __ Base Neutral Extractables' (625/8270).' _ Diquat (549) ><GC/MS Unknown' Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates'(6p6MS'). ' Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other:____________ ■ _________ • __ Other Pesticides (SMI8/6630) pH ___________ _UCMRList1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Aridity. -'Aluminum .■__ Potassium __ Turbidity __ Alkalinity _ Antimony ^--Selenium _ pH __ Bromide ^Arsenic ^Silver __ Conductivity __ Bromate/Chlorate/Chlorite ___Barium _ Sodiurfi __ Corrosivity (temp:. ’C) __ Chloride _ ^.-Beryllium . u-‘Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium . __ Carbonaceous BOD (5 day) __ Fluoride _;Cadmium _::rZinc _ Soluble BOD (5 day) __ Hardness. Total as CaCOs __ Calcium, as CaCOa CLP ' " __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium. Ca*^ __ Dissolved Oxygen __ Nitrogen,'Nitrate as N . ^Metals/CN _-Chromium,’ Total __ Total Organic Carbon _ ; Volatiles J_ Nitrogen. Nitrite as N __ Chromium. Hexavalent ' '__ 'Semi-violatiles _ __ Total Organic Halides _L Nitrogen. Total Kjeldahl as N ^■Cobalt __ Solids. Percent (%) Pesticidds/PCB’s , __ Oil and Grease '-Copper ;__ Solids. Settleable . __ Phenol "-•Irori _ Solids. Suspended __ Phosphorus Total as P- _!rLead ;tclp ’■—TCLe-Metal^ __ Solids. Total ■ __ Phosphorus.- Ortho as P-' __ Magnesium ; • •_tCLR-Pesticicles. __ Solids. Total Dissolved. ",_ Sulfates, _>-Mdnganes^e' _TCLP-Herbicides- f __ Solids. Total Volatile Surfactants ---Mercun/'. ’ _TCLR-:Volatiles, Other: _ ______ _ UV254, . ' ^Molybdenum, ) _TCLP-BNA’s' L?NicRei; .J- s 1^-. . — - 'I','' . ’S* A .• /sE-vL . J'*'.’ •S’l ii - A; NYC-WTC_000073455