Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document ■ I . ’i- ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 'V /I estchester r WESTCHESTER COUNTY LABORATORIES AND RESEARCH ‘ ^ggpvcom, fl ¥■' , 2 Dana Road, .Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 ‘f -f .£/, / r y <) /, ■ ^4 sd K • , - "Y ■ "/-..NYS-ELAP r!lo. 10108 Time/Date Set: I Form A-70 (rev. 10/01) a

f - / I Sample Type (circle one):" 1. Potable ‘ ■^.?Non Potable - 3: Non Potable Treated 4. Other t ‘ n.......... ' ,

Bottle #’s: ' ! Chain of Custody?___ Yes No ! " i f- .■Time/Date Collected:

' Collected Bv: / ’ I Z/ 7bA., L— Agency Code: Comments:. PWS #: Bill' to: Source ID: Type. Descriptor:

I. • Collected From: . ■ Location’s/lndividual’s Name 'Vivifi i'jh-'rnh -Name/Company

fc •. Street - =City/St/Zip___________ __ ' Street City/St/Zip • 1' £ ,identification of Source Phone#: , Fax#: i Collection Point - CA.CH, Bl? Check#: ■AmouritS I

BACTERIOLOGICAL ANALYSIS Lab#:_____________ J Lab#: ____ . ■ U-- ORGANIC POTABLE analysis; ORGANIC NONPOTABLE/SOLID ANALYSIS Heterotrophic Plate Count __ Trihaiomethanes (524) __ Purgeable Halocarbons (624/8260)- t (hempdialysis & all others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260)

r Coliform P/A (Public supplies) £2. Coliform MPN (priv well, raw, stp) _J;.:Fecal Coliform (all samples), __ Volatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Microextractables (504) ’ ’ ■ ’ Acrolein & Acrylonitrile (8260) ' __ O’rganochlorine Pesticides (608/8081) i __Microscopic _ PCB’s (Arochlors) (608/8081) i-. [ Ma“croscopic, __ Pesticides/PCB screen (508) » _ Herbicides (SM18/6630,8151) ir API __ PCB as Decachlorobiphenyl (508A) Other Pesticides (SMI8/6630)

iff Other:__________ _____________

yes__ < no _ Herbicides (515) __ Pesticides (525) __ Carbamate Pesticides (531) __ Petroleum Hydrocarbon Scan (310-13). __ Glycols in Water > __ Acid Extractables (625/8270) i ' I® yRefrigerated? Chlorinated:?' yes I _ Glyphosate (547) __ Base Neutral Extractables (625/8270) __ Diquat (549) 2i'GC/MS Unknown Scan Free Chlorine Res: - mg/L I f ;1 __ Chlorination Disinfection Byproducts (551), _ Phthalates (606MS) __ Haloacetic Acids (552) __ Other: ‘ ILZl. Il' pH Total Chlorine Res: ■«» _ &________________________________ -mg/L

I _ Other Pesticides (SM18/6630) __ UCMRListI ^MtBE Only (524) . ' ' ' ’ RADIOCHEMICAL ANALYSIS • Radon __ Other. J. I 1 , T ft INORGANIC ANALYSIS REQUESTED - Lab#: Color Turbidity J ’ - Acidity ” • __ Alkalinity __ Aluminum . Potassium __ Antimony __ Seleniurh ’Iv __ Bromide __ Arsenic , . __ Silver .P _ Conductivity Corrosivity (temp:___ .°C) __ Bromate/Chlorate/Chlorite __ Chloride . __ Barium __ Beryllium - __ Sodium’ __ Thallium f

V. ;boD (5 day). . | '—L. Cyanide ■ __ Boron :__ Vanadium » Carbonaceous BOD (5 day) __ Fluoride _:_Cadrhiurh -1- Zinc .J, Soluble.BOD (5 day) ' __ Hardness, Total as CaCOa __ Calciumi-as CaCOs CLP " V. Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca+2 Dissolved Oxygen __Nitrogen, Nitrate as N __ .Chromium, Total , __ Metals/CN f

I Total Organic Carbon Total Organic Halides ■'_L Solids, Percent (%) • ' __ Nitrogen, Nitrite as N __ Nitrogen, Total Kjeldahl as N Oil and Grease __ Chromium, Hexavalent __ .Cobalt __ Copper __ Volatiles __ Semi-violatiles __ Pesticides/PCb’s i B- _ Solids, Settleable I >1 Solids, Suspended __ Phenol .__ ; Phosphorus Total as P _2_ Iron •' __ Lead ,■ " tcLp ■ ' 1 1 I; _ Solids, Total __ Phosphorus, Ortho as’P __ Magnesium • "■ _TCLP-Metals j , __ TCLP-Pesticides I Solids, Total Dissolved _ Sulfates __ Manganese- k ' Solids, Total Volatile '■__ Surfactants ' Mercury • _TCLP-Herbicides 'i_TCLP-V6latiles‘ 1 ‘ __ Other:___________ _______ UV254 J_ Molybdenum ’ ___TCLP-BNA’s ; . i I _ Nickel 1 1 I t I' I . J. NYC-WTC_000073598