Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document I ■ a

4 .^stchester ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■ t -T vox.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 o (914)231-1620 Fax (914)231-1772

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

Sample Type (circle one): 1. Potable 3. Non Potable Treated Bottle #’s: •J ' ? I- 2. Non Potable 4. Other___________ Chain of Custody?___ Yes No Time/Date Collected: / ' r Comments: I ■ Collected By: > Agency Code: PWS #:______ Source ID: Type Descriptor: j Collected From: Bill to: Location's/lndividual’s Name Name/Company J Street_________________ Street_______ City/St/Zip________ City/St/Zip Identification of Source Phone#: Fax#: Collection Point 1 CA,CH, Bl? Check#: Amounts, s -j BACTERIOLOGICAL ANALYSIS Lab#:_______________________ Lab#: a • 'v’

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) __ Organochlorine Pesticides (608/8081) A? __ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) I __ PCB as Decachlorobiphenyl (508A) _ API _ Other Pesticides (SMI8/6630) __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) ! __ Other:_____________________ __ 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) I _ Phthalates (606MS) Total Chlorine Res: pH ___________ . mg/L __ Haloacetic Acids (552) __ Other Pesticides (SM18/6630) __ Other:____________________________ i _UCMR List 1 RADIOCHEMICAL ANALYSIS __ MtBE Only (524) I __ Radon __ Other____________________ I INORGANIC ANALYSIS REQUESTED - Lab#: __ Color 5 __ /\cidity I-'Aluminum __ Potassium __ Turbidity __ Alkalinity _/'Antimony jil'Selenium _ pH __ Bromide -/•Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite _Barium __ Sodium I __ Corrosivity (temp:. °C) __ Chloride .^'Beryllium __ Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium __ Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand CLP __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Dissolved Oxygen _ Metals/CN __ Nitrogen, Nitrate as N _^Chromium, Total __ . Total Organic Carbon __ Volatiles __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Total Organic Halides __ Semi-violatiles __ Nitrogen, Total Kjeldahl as N ^Cobalt ■4 __ Solids, Percent (%) __ Pesticides/PCB's __ Oil and Grease --'Copper __ Solids, Settleable __ Phenol __ Iron ICLP __ Solids, Suspended __ Phosphorus Total as P Lead __ Solids, Total __ TCLP-Metals __ Phosphorus, Ortho as P __ Magnesium __ Solids, Total Dissolved __ TCLP-Pesticides __ Sulfates ^Manganese __ Solids, Total Volatile __ TCLP-Herbicides __ Surfactants Mercury __ Other: ~____________ _ TCLP-Volatiles _ UV254 Molybdenum _ TCLP-BNA’s Nickel

NYC-WTC_000073509