Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document . ' • « ri - ■ ... r

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ‘ .n^stchester , WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772- I' NYS-ELAP NoJ iOIOSf 4 , Time/Date Set: Form A-70 (rev.10/6l)} ' -Q,. II ’ ------ ----------- 1—--------------- ---- 4 P.. ■ 'I •I Sample Type (circle one): ,^1. Potable 3. Non Potable Treated Bottle #’s: ZO ' ■ '■ 1 ■ '3 2. Non Potable 4. Other W.-■ Chain of Custody?'___ Yes No ■4

Time/Date Collected: Collected By:__ t *■—--Agency Code: Comments: PWS #: . Source ID: Type Descriptor: I Collected From: Bill to: i. * ( ■: Location’s/lndividual's Name Name/Corhpany

I I Street________ ________ Street City/St/Zip - City/St/Zip )■ "3 s J i < If Identification of Source Phone#: Fax#:,

i Collection Point 1 CA,CH, Bl? Check#: Amounts I -

BACTERIOLOGICAL ANALYSIS' Lab#: Lab#: ■ .______________

II ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS : __ Heterotrophic Plate Count' (hemodialysis & all others) __ Trihalomethanes (524) ‘ _1 Purgeable Halocarbons (624/8260) __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) . .'■& __ Coliform MPN (priv weil, raw, stp) _ Volatile Aromatics (524) __ Acrolein & Acrylonitrile,. (8260) ]■

i __ 'Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Microextractables (504) __ O'rganochlorine Pesticides .(608/8081) 7 __ PCB’s (Arochlors) (608/8081) p- ; 7', i 3 __ Microscopic -__ Macroscopic Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,8151) j- _ API ■ __ PCB as Decachlorobiphenyl (508A) ■ _ Other Pesticides (SM18/6630) | ''

5 __ Other:_____________________ __ Herbicides (515) ' ' *__ Petroleum Hydrocarbon Scan (310-13) _ Pesticides (525) _ Glycols in Water j <‘^’7- Refrigerated? 'yes no . __i Carbamate Pesticides (531) ’ - _ Acid Extractables (625/8270) Chlorinated:? __ - yes___ ho ‘ ,_ _Glyphosate (547) Base Neutral Extractables .(625/8270) __ Diquat ‘(549) j_^GC7MS Unknown Scan ' - 7 Free chlorine Res:, mg/L __ Chlorination Disinfection Byproducts (551) Phthalates (606MS) ' } i Total Chlorine Res: mg/L __Haloacetic Acids (552) __ Other:_________

ft*———— RADIOCHEMICAL ANALYSIS _ Other Pesticides (SMI8/6630) •_ UCMR List 1 _MtBE Only'(524) ‘ L- a (__ Radon __ Other___________________ ’ 7... r. $ ■ i* s INORGANIC ANALYSIS REQUESTED - Lab#:._ ■■ u !■«

__ Color __ Acidity , ^''Aluminum __ Potassiu’m t si? __ ' Turbidity — pH __ Alkalinity __ Bromide Antimony - -- Arsenic ■--^Selenium ^'Silver J ‘__ Conductivity '__ ’Corrosivity (temp:. _ BOD (5 day) __ Carbonaceous BOD" (5 day) °C) Bromate/Chlorate/Chlorite __ Chloride __ Cyanide __ 'Fluoride .-■Barium .,_£:fBeryllium __ Boron _l_Cadmium __ Sodium jafThallium , __ Vanadium' I r !

3 :_^-Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOa _ Calcium, as CaCOa “CLP __ Chemical Oxygen Demand __ ;Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Dissolved Oxygen _Metals/CN . Nitrogen, Nitrate as N v^-Chromium, total ■__ Total Organic Carbon - Total Organic Halides __ Nitrogen, Nitrite as N __ Nitrogen, Total Kjeldahl as N Chromium, Hexavalent ■J^Cobalt __ Volatiles ■__ Semi-violatiles , L • - A I- __ Solids, Percent (%)^ __ Pesticides/PCB's __ Oil and Grease ^--Copper I ■- Solids, Settleable __ , Solids, Suspended __ Solids, Total Phenol __ Phosphorus Total as P __ Phosphorus, Ortho as P _2'lrdn _::::Lead . __ Magnesium ICLP _TCLP-Metals j - 't 1 __ Solids, Total Dissolved __ TCLP-Pesticides 1 __ Sulfates _^-Mangahese ■f Solids, Total Volatile ■ zbther:_________ _ : Surfactants _ UV254 Mercury ^Molybdenum _>'Nickel __ TCLP-Herbicides _ TCLP-Volatiles _TCLP-BNA’s I 3 i. NYC-WTC_000073482