Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document ’J ’■F

) ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster ivcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, .Valhalla, New York 10595 .4^ Si (914)231-1620 Fax (914) 231-1772 I -NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.10/01)

Sample Type (circle one); (pPotable 3. Non Potable Treated Bottle #'s: O 2. Non Potable 4. Other Chain of Custody? Yes No Time/Date Collected: '» z- n 2- Comments; Collected By: L Agency Code: PWS #:________ Source ID: jType Descriptor: Collected From: Bill to: Location's/lndividual’s Name Name/Company, Street \ i/\) F I Lift PSf t v'ff Street_________ City/st/zip 1 h/t }If?., My iS, City/St/Zip Identification of Source___________ _____________ Phone#:_______ Fax#: Collection Point. ?> / / //__________ I CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:________________ _ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & all others) __ TOhalomethanes (524) ___ Purgeable Halocarbons (624/8260) I _i!/volatile Halocarbons (524) ___ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) . X/olatile Aromatics (524) , Acrolein & Acrylonitrile (8260) __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) __ PCB’s (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides. (SM18/6630,8151) 1 I _ API __ PCB as Decachlorobiphenyl (508A) - Other Pesticides (SMI8/6630) __ Other:_____________________ __ Herbicides (515) __ Petroleum Hydrocarbon-Scari (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) _!£^C/MS Unknown Scan Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res: . mg/L __ Haloacetic Acids (552) Other: _______ _____________ _ Other Pesticides (SMI 8/6630) ,PH ___________ _UCMR Listi RADIOCHEMICAL ANALYSIS __MtBE Only (524) __ Radon __ Other.

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity _t;^^luminum •' Potassium r __ Turbidity __ Alkalinity ■ «»^ntimonv !i^lenium pH _ Brorhide jZArsenic Ji:^lver __ Conductivity __ Bromate/Chlorate/Chlorite jZoarium __ Sodium '__ Corrosivity (temp:. .“C) __ Chloride jiZ^eryllium _Se-nTalIium _ BOD (5 day) __ Cyanide __ Boron __ ^nadium __ Carbonaceous BOD (5 day) __ Fluoride .^ZCadmium _l!<;anc __ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs __ Chemical Oxygen Demand CLP __ Nitrogen, Ammonia as N __ Calcium, Ca*^ __ Dissolved Oxygen iZ^hromium, Total __ Metals/CN __ Nitrogen, Nitrate as N __ Total Organic Carbon __ Volatiles __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N .i^obalt __ Pesticides/PCB’s __ Solids, Percent •(%) __ Oil and Grease jZCopper __ Solids, Settleable . __ Phenol v^on TCLP __ Solids, Suspended __ Phosphorus Total as P JifLead _TCLP-Metals __ Solids, Tota( __ Phosphorus, Ortho as P __ ^gnesium __ Solids, Total* Dissolved __ TCLP-Pesticides __ Sulfates Ja^Wnganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants _u^wrcury _ TCLP-Volatiles Dther: __________ _ UV254 _tij0E)lybdenum , _^ickel _ TCLP-BNA’s

NYC-WTC_000073529