Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document ' ' , '''' ' ATT .1 . ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM . WESTCHESTERCOUNTYLABORATORIES AND RESEARCH ' 2Dana’Road, Valhalla, New York 10595 i ‘ • J, (914)'231-1620 Fax (914) 231-1772 < (JLJHbuihSAaaj x --f " NYS-ELAP No. 10108 f K.. Time/Date Set: Form A-70 (rev.10/01) 4

^arnple Type (circle one): 1.- P- p., 77/? (;T. Potable 3. Non Potable Treated Bottle #’s: ._____________ ________ 'STNon Potable ‘ 4. Other Chain of Custody?Yes No F sr' time/Date Collected: Comments:_______I *___________________ -___________________

■I' . Collected By: —> • /I ■ Agency Code: PWS #: Source ID: Type Descriptor: *'■ Collected From: • Bill to: /*> M i./ ) -s ■■ * • Narne/Company ( । Location’s/lndividual's Name r ■ Street____________________ Street 1 City/St/Zip __ _____________ City/St/Zip ' -I

Identification of Source Phone#: i Fax"#:

Collection Point - rCA,CH, Bl? Check#: Amounts I

w' BACTERIOLOGICAL ANALYSIS Lab#: 4 1'

Lab'#: \ ' ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS _ Heterotrophic Plate Count __ Trihalomethanes (524) /_ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv'well, raw, stp) __ Volatile Aromatics (524) Acrolein & Acrylonitrile (8260) __ J Fecal Coliform (all samples) Total Trihalomethane Potential .(510) <__ Organochlorine Pesticides (608/8081) O' _ Microscopic __ Microextractables (504) _ PCB's (Arochlors) (608/8081) ,

i _„API Macroscopic

Other:____________ I _ Pesticides/PCB screen (508) __ PCB as Decachlorobiphenyl (508A) _ Herbicides (515) ' , , , Herbicides (SMI8/6630,8151) . 1_ Other Pesticides'' (SM 18/6630) - Petroleum’Hydrocarbon Scan (310-13) __ Pesticides (525) ' < •'Glycols' in Water' Refrigerated?yes no __ Carbamate Pesticides (531) ■ 11. Acid Extractables (625/8270) __ .Glyphosate (547) Lt, Bas'e Neutral Extractables (625/8270) & Chlorinated:? yes no “J>'^GC/MS Unknown Scan _ Diquat (549) , Free Chlorine Res:J mg/L ___ Chlorination Disinfection Byproducts (551) _ 'Phthalates (606MS) 'M' Total Chlorine Res: . mg/L ■ j _ Haloacetic Acids (552)' __ . Other:_________________________ _

h _ Other Pesticides (SM18/6630) ,5 ■ ! ' 1 '•% ^H _________ L_ 1 _'UCMR List 1 - >5-: y, t . RADIOCHEMICAL ANALYSIS _ MtBE Only (524) ! ti- Radon Other. F INORGANIC ANALYSIS REQUESTED - Lab#:l I

V, ■ 'll J

Color __ Acidity Aluminum __ Potassium __ -Turbidity __ Alkalinity __ ; Antimony Selenium t. pH __ Bromide Arsenic 'i- Silver t __ Conductivity __ Bromate/Chlorate/Chlorite Barium ' . ( j _1 Sodium ■ _i Corrosivity (temp:, .°C) - ___ Chloride _. Beryllium ’ . ’. Thallium BOD (5 day) ■ _ Cyanide __ Boron _ ' { __ Vanadium ;;_ Carbonaceous BOD (5 day) Fluoride _Cadmium J , ■_T-'Zinc M ", _ Soluble BOD-. (5 day) ’ .___ Hardness, Total as CaCOs ..__ Calcium, as CaCOs " rcLP^ ~ I- _ Chemical Oxygen Demand j __ Nitrogen, Ammonia as N __ Calcium, Ca*2 _ Dissolved Oxygen' __ Metals/CN __ Nitrogen, Nitrate as N .^Chromium, Total j __ Volatiles - Total Organic Carbori __ Nitrogen, Nitrite as N __ Chromium, Hexavalent t ’W Total Organic Halides' 1 - __ Nitrogen, Total Kjeldahl as N ._2:^Cobalt t __ Semi-violatiles Solids, Percent (%) _ Pesticides/PCB’s _ Oil and Grease _t.Copper __ -Solids,^ Settleable Iron " I ■ .__ Phenol TCLP __ Solids, Suspended Phosphorus Total as P -Lead Solids,' Total __ Phosphorus, Ortho as P __ Magnesium •J i_TGLP:Metals _TCL P-Pesticides " __ Solids, Total Dissolved _ Sulfates . .•Manganese 1 __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants __ Mercury ! _TCLP-Volatiles ■.< Other: ■ _______ _ UV254 '__ Molybdenum r- - _Nickel _ TCLP-BNA’s I “ I I 1 . 4. NYC-WTC_000073575