Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document a J. • - A... - .. ■ I

J^tstdiester . ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM . WESTCHESTER COUNTY LABORATORIES AND RESEARCH - , 2 Dana Road, Valhalla, New York 10595 /1 '-I ,, , ' ■ (914)231-1620 Fax (914) 231-1772 ,2 /I LHbaO/^aJ 5 2 '* i •1 I ■j< NYS-ELAP No. (16108 I -Time/Date Set: - -^Form A-70 .(rev/l0/01)'|^^

Sample Type (circle one). ...J''’" ; t.fPotable > , 3. Non Potable Treated • Bottle #’s: 2 .Lt.:.-” ; « 2. Non Potable - 4. Other ; . JL.’ Chain of Custody?___ Yes 1 No ' S' ■ J ■ > -1 ■ YrTirfie/Date Collected: '" •'< . Comments: • V •5*’ : ■"Collected, By: Agency Code: PWS #:__________ Source ID: J__ Type Descriptor: Collected From: -Bill to: I 4 'h- ' Location’s/lndividual’s Name Name/Company__ l 1

Street_______________________ Street________ __ I ’ T City/SWZip______________ ___ , City/St/Zip , V

Identification of Source . Phone#: Fax#: Collection Point CA,CH, Bl? Check#: Amounts . f r-- ;// I f

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BACTERIOLOGICAL ANALYSIS Lab#: Lab#: _J____________________ _2_ ORGANIC NONPOTABLE/SOLID ANALYSISf ORGANIC POTABLE ANALYSIS

I __ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) i __ Purgeable Halocarbons (624/8260)' • ’ Coliform P/A (Public supplies) ■ ‘ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260)' i. ’ __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524)' , . . __ ' Acrolein & Acrylonitrile (8260) )■ .J; t __ Fecal Coliform (all samples) _ , __ Total Trihalomethane Potential ’(510)' __ Organochlorine Pesticides (608/8081) _ Microscopic ' j __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) - ’ 2' __ Pesticides/PCB screen (508) _ Herbicides'(SM18/6630,8151) ' _ __ Macroscopic

I- __API __ PCB as Decachlorobiphenyl (508A) __ Herbicides (515) Other Pesticides (SM18/6630) , i -V. s..__ Petroleum Hydrocarbon Scan (310-13j;-^. I .__ 'Other:'____________ __ Pesticides (525) __ Glycols in Water ’ ' .• -f 1 Refrigerated?yes no __ Carbamate Pesticides (531) ■■ Acid Extractables (625/8270) Y-J, / yJ' Chloririated:?yes Free Chlorine Res: Total Chlorine Res: pH _____________ no . mg/L . mg/L __ Glyphosate (547) __ Diquat (549) ■__ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) __ Other Pesticides (SMI8/6630) ' UCMR List ,1 _ ■ Base' Neutral Extractables (625/8270) ■ ’ GC/MS Unknown Scan .. _ Phthalates (606MS) __ Other: i . , vtJY ____________________ 4___ ’ ■ t II I ___Radon RADIOCHEMICAL ANALYSIS

__ Other - __________ _MtBE Only (524) ’ i. INORGANIC ANALYSIS REQUESTED - Lab#: __ Color J ,__ Turbidity _'pK ‘ __ Acidity . __ Alkalinity "__ 'Bromide < > __ .Aluminum __Antimony, __ Arsenic i __ Potassium _ Selenium __ Silver I ■j)-. 13 __ Conductivity 1 Bromate/Chlorate/Chlorite ■ __ Barium __ Sodium __ Corrosivity (temp:. __ Chloride ^Beryllium Z_’Thallium ■m: '1 i-r _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5’day)’ __ Fluoride’ __ Cadmium " __ Zinc. Jl’ _ Soluble BOD'(5 day) ' ‘___ Hardness, Total as CaCOa ■__ Calcium, as CaCOa __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N ■■ __ Calcium, Ca*2^ "CLP 4 _Metals/CN , ( ' , __ Dissolved Oxygen' __ Nitrogen, Nitrate as N __Chromium, Total • __ Volatiles ’ __ Total, Organic Carbon ___ Nitrogen, Nitrite as N' __ Chromium, Hexavalent I , _2_ Semi-violatiles | _ Total Organic Halides r- __ Nitrogen, Total Kjeldahl as N Cobalt. !• __ Solids’ Percent (%) ' Pesticides/PCB's ' _ Oil and Grease _Copper . , fit __ Solids, Settleable __ Phenol 1 ■ Iron Mt tclp __ Solids, Suspended __ Phosphorus Total as P Lead __ Solids, Total _TCLP-Metals __ Phosphorus, Ortho as P __ Magnesium' __ Solids, Total Dissolved j _TCLP-Pesticides _i. Sulfates' __ Manganese __ TCLP-Herbicides' __ Solids, Total Volatile " '__ Surfactants Mercury ■ Other: Szr.. - ■ _ TCLP-Volatiles 1 _ UV254 , Molybdenum : _ TCLP-BNA’s ' __ Nickel , 1 I { J NYC-WTC_000073478