Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document I ’

ACCo. ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road,- Valhalla, New York 10595 ‘ I (914) 231-162'0 Fax (914) 231'-1772 1: NYS-ELAPNo. ?0108 Jime/Date Set: I J ' i' / Form A-70 (rev.10/01)*

Sample Type (circle one); 1 7: r Bottle #’s: J T -,1. Potable ■ 3. Non Potable Treated ' ‘ ' i ♦ L 2/ Non Potable 4. 'other_______ ______ Chain of Custody?____ Yes____ No Time/Date Coiiected: Comments: ■ t Collected By: i Agency Code: PWS #:_______ Source ID:- I Type Descriptor: Collected From:,, “bin to:

Location’s/lndividual’s Name Name/Company '.. -i ’ Street______ .______ . Street r „ I ‘ City/St/Zip .______ _________ City/St/Zip 1

Identification of Source Phone#: » ~ .Fax#: Collection Point_______ 2_ CA,CH,.BI? iLCheck#: j: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: 4^ ■t 4 Lab#:L f. -4 , 't- t , . ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS t 'T- __ Heterotrophic Plate Count __ Triri'alomethanes (524) __ JPurgeable Halocarbons (624/8260) K- (hemodialysis & all others) __ Coliform P/A (Public supplies) '' Volatile Halocarbons' (524) Purgeable'Aromatics (624/8260) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260), __ Total Trihalomethane Potential (510) __ Organochldrine Pesticides (608/8081) __ Fecal Coliform (all samples) __ Microextractables (504)" ~ PCB's (Arochlors) (608/8081) __ Microscopic __ Macroscopic ■ -. __ Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,8151) __ PCB as Decachiorobiphenyl (508A)‘ _ Other Pesticides (SMI8/6630) r- _ API __ Other: , _________________ __ Herbicides (515) Pesticides (525) .__ Petroleum Hydrocarbon Scan (310-13) Glycols in’Water ,, i. Refrigerated?yes no- _ Carbamate Pesticides (531) ‘ _ -Acid Extractables (625/8270) _ ’ _ Glyphosate (547) __ 'Base Neutral Extractables (625/8270) , Chlorinated:? yes no __ Diquat (549) ’ _t/'GC/MS Unknown Scan Free Chlorine Res: mg/L _ Chlorination Disinfection Byproducts. (551) Phthalates'(606MS) Total Chlorine'Res:__ u . mg/L __ Haloacetic Acids (552) ■ __ , Other:_______ _________________ ________ I __ Other Pesticides (SMI8/6630) I pH _________ J_UCMRList1 . ■ ' T I. RADIOCHEMICAL ANALYSIS _ MtBE Only (524) f __ _Radori _ Other. J

INORGANIC ANALYSIS REQUESTED -Lab#:* i2Z I _ Color •__ Acidity ' ■ ' ' Alumirium __ Potassium __ Turbidity - r _ Alkalinity »■ - Antimony^ I Selenium pH . __Bromide _ L Arsenic ■ -s ^Silver J _ Conductivity , __ Bromate/Chlorate/Chlorite _ Barium I ■ __ Sodium Corrosivity (temp:. °C) ___Chloride Beryllium ' I I J_ Thallium I f BOD (5 day) ’ __ Cyanide __ Boron “___Vanadium __ Carbonaceous BOD. (5 day) __ Fluoride,^ __ Cadmium jLi''^inc ft. /__ Soluble BOD (5 day) ‘ __ Hardness,' Total 'as CaCOa __ Calcium, as'CaCOs ■__ Chemical Oxygen Dem'and . _"'Nitrogen, Ammonia as N __ Calcium, Ca+2 1 Tlp " __ Dissolved Oxygen __ Nitrogen, Nitrate as N ’ i. _ Metals/CN _l;Chromium, Total _ Total Organic Carbon __ Nitrogen, Nitrite as N I. __ Volatiles ' ^ Chromium, Hexavalent f __ Se'mi-violatiles __ Total Organic Halides ■__ Nitrogen, Total Kjeldahl as N YCobalt ' J __ Solids', Percent (%) r __ Oil and Grease _LCopper _ Pesticides/PCB’s ’__ Solids, Settleable • _ Phenol Jr.'Iron ’ I ICLP A, __ Solids, Suspended , J __ Phosphorus Total as P V . Lead _ Solids, Total -f _TCLP-Metals __ Phosphorus,'Ortho as P ‘ __ Magnesium __ Solids, Total Dissolved __ TCLP-Pesticides 1 __ Sulfates Manganese __ Solids, Total Volatile __ TCLP-Herbicides '__ Surfactants Mercury Other: ' ■' .. ) _TCLP-Volatiles _ UV254 ^'Molybdenum _ TCLP-BNA's Nickel ■} L I ■I- I, NYC-WTC_000073572