Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document f ' I ' ■ • 'I. •i ‘

AVpQfrbpQfpr 3 environmental SERVICES sample SUBMISSION FORM r WESTCHESTER COUNTY LABORATORIES' AND RESEARCH ; 2 Dana Road, Valhalla, New York 10595 rtf f ' , - (914) 231-1620 Fax (914) 231-1772 ' ' " . LF I • ' NYS-ELAP NoJ.IOIOS.FS Time/Date Set: * > ' 'k Form A-70 (rev.10/01) t I i Sample Type (circle one): ! * —--------- T—ni F.',!

! Bottle #'s:________L_ i f.. J { 1. Potable- 3. Non Potable Treated 2. Non Potable 4. Other • t Chain of Custody? Yes No • Time/Date Collected: : 1 Comments: 'f 'i.

Collected By: Collected From: Agency Code: ? f- PWS #:____________ Bill to: Source ID:. Type Descriptor: 2 I Location’s/lndividual’s Name 1 >■ ? Name/Company __ j. 'S Street____________________ Street_____________ Gity/SUZip___________ . City/St/Zip_________ Identification of Source Phone#:___________ Fax#: .1 ' 'i, T ! Collection Point • >. \1 / * Amounts. 3 1 CA,CH, Bl? Check#: 1 BACTERIOLOGICAL ANALYSIS Lab#: - F" I l' ■ Lab#: ~ Heterotrophic Plate Count ORGANIC POTABLE ANALYSIS __ Trihalomethanes (524) ORGANIC NONPOTABLE/SOLID ANALYSIS^ '_j_ Purgeable Halocarbons (624/8260) ' '■ / , I I (hemodialysis & all others) _ Volatile Halocarbons (524) , ■ __ Purgeable Aromatics (624/8260).f ■ FF __ Coliform P/A (Public supplies) •__ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) ' 'rt ' _ Coliform MPN (priv well, raw, stp) __ _Total Trihalomethane Potential (510)' ■ _ Organochloritie Pesticides (608/8081). Ft' __ Fecal Coliform (all samples) —■ " ■ • ' —........................... ' ■ __ Micfoextractables (504) ' PCB's (Arochlors) (608/8081) __ Microscopic ■ _2 Macroscopic , __ Pesticides/PCB screen (508). _ Herbicides (SMI8/6630,8151) , _ API . ' _2 PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SM18/6630) • , __ Other: ____________ __ . Herbicides (515) _ Pesticides (525) _ Petroleum Hydrocarbon Scan (310-13)'; '*■ ' _ Glycols in Water , -I a.fc a Refrigerated?__ L'yes Chlorinated:? yes no no i __ Carbamate Pesticides .(531) _ Glyphosate'(547) _ Acid Extractables (625/8270) ] , .kF __ : .Base Neutral Extractables (625/8270), Fi k _ Diquat (549) Y GC/MS Unknown Scan Free Chlorine Res: __ Chlorination Disinfection Byproducts (551)- __ Phthalates (606MS) Total Chlorine Res: . mg/L __ Haloacetic Acids (552) ' • _2_ Other:■ J •t " ’

pH J______ _ _Other'Pesticides (SMI8/6630). _ UCMR List 1 - ._\MtBE Only (524) ------- . r.i- ■Ft ■ i RADIOCHEMICAL ANALYSIS ___ Radon r

__ Other .

INORGANIC ANALYSIS REQUESTED - Lab#:' __ Color, J ^5 k __ Acidity [ __ Aluminum _ Potassium' 2 __ Turbidity __ Alkalinity -' __ Antimony _ Selenium , f pH Bromide _ Arsenic , Silver __ Conductivity _ Bromate/Chlorate/Chlorite __ Barium ' - Sodium __ Corrosivity (temp:. - BOD (5 day) .‘’C)

__ 'Carbonaceous BOD (5 day) ' __ Chloride __ Cyanide __ Fluoride I _ Beryllium . _ Boron __ Cadmium I __ Thallium- __ Vanadium- __ ’ Zinc r i

J' k I- __ Soluble BOD (5 day) __ Hardness. Total as CaCOa 2_ Calcium, as CaCOa __ Calcium, Ca'*^2 CLP __ Chemical Oxygen Demand . ;__ Nitrogen, Amrrionia as N __ Dissolved Oxygen . __ Total Organic Carbon __ Nitrogen, Nitrate^ as N __ Nitrogen, Nitrite as N __ Chromium, Total __ Chromium,-Hexavalent _ Metals/CN { _ Volatiles I __ Total Organic Halides Solids, Percent (%) __ Nitrogen, Total Kjeldahl as N __ Cobalt __ Semi-violatiles __ Pesticides/PCB's' ■a __ Oil and Grease' __ Copper I ■ ( __ _ Solids, Settleable -__ Phenol c. __ Iron TCLP •' 1 __ Solids, Suspended __ Phosphorus Total as P . __ Lead "3 __ Solids, Total __ Solids, Total Dissolved __ Solids, Total Volatile __ 'Phosphorus' Ortho as P ___ Sulfates __ Surfactants __ Magnesium- __ Manganese _ Mercury t _TCLP-Metals '__ TCLP-Pesticides _TCLP-Herbicides s _ Other: 2_______ _ ___ UV254 ' »• ___Molybdenum _ TCLP-Volatiles _ TCLP-BNA’s l ■i 4 ( __ Nickel I S. NYC-Wtc_000073484