Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

........ .... .. .. .... ....... ........ .......... .. ................... ...... ... ................ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM .. ‘ •Ski- I ,\.C( Mil: WESTCHESTER COUNTY LABORATORSrS AND RFSFARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 sZr

NYS-ELAP No, 10108 Time/Date Set: Z f f\ Form A-70 (rev. 10/01)

Sample Type (circle one): . zzn Q/Potable 3. Non Potable Trea/ed Bottle #’s: 2. Non Potable 4. Other Chain of Custody?Yes No Z Time/Date Collected:__________________ : Z 7 < .e: Gommciith . . _______ I■ Collected By: L_ IZiOj-lZZ__ Agency Code: PWS#: _ Source ID: . ID: ... ...... iype Doscnptor. ........ Colloctod From: Bill to: Location's/'" '■ '"'■ ai’s Name__ _________ Or Name/Company Street J ' ' ’ //■-/■___________________: Street ___ City/St/Zip \Ji y/n ; .•___ .v, y____ ; , <. -/q City/St/Zip Identification of Source_________________________ : Phone#:_______ Fax#: — Collection Point__ /__________ i i________________ _ CA.CH, Bi? Check#: Amounts:

II BACTERIOLOGICAL ANALYSIS Lab#:^ Lab#:_______________________ _ __ Heterotrophic Plate Count ORGANIC POTABLE ANALYSIS __ T.hhalomeShanes (524) ORGANIC NONPOTABLE. SOLID ANALYSIS ___ Purgeable Halocarbons (624/8260) i ■ (hemodialysis & all others) .iZVpIatiie Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp): .Z/olatiie Aromatics (524) __ Acrolein & Acrylonitrile (8260) _ _ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Oi-ganochlorins Pesticides (608/8081) is __ Microscopic __ Macroscopic _ API __ Microextractables (504) __ Pesticides/PCB screen (508) __ PCB as Decachlorobiphenyl (SOSA) ___ PCB’s (Arochlors) (603/8081) Herbicides (SM18/6630,8151) _ Other Pesticides (SMI8/6630) I _ _ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Other:: Refrigerated?yes no __ Pesticides (525) Carbamate Pesticides (531) __ Glycols in Water Acid Extraclables (625/8270) I Chlorinated:?yes no __ Glyphosate (547) __ Diquat (549) __ Base Neutral Extractables (625/8270) ; ..-G'C/MS Unknown Scan ■ Free Chlorine Res:, - mg/L __ Chlorination Disinfection Byproducts (551) Phthalates (606MS) Total Chlorine Res: , mg/L __ Haloacetic Acids (552) __ Other:’ 1 _ Other Pesticides (SMI8/6630) pH __________ _UCMRUst1 RADIOCHEMICAL ANAL YSIS _ MtBE Only (524) __ Radon _ Other: ■ INORGANIC ANALYSIS REQUESTED - i.ah# __ Color __ Acidity jXAIuminum __ Potassium __ Turbidity __ Alkalinity jZ^ntimony j^elenium _ pH __ Conductivity _ _ Corrosivity (temp.; .“C): __ Bromide __ Bromate/Chlorate/'Chiorite __ Chloride jZ'/ysenic _txBarium JSifBeryllium . ... Thjiliiim ■fl BOD (5 day) __ Carbonaceous BOD (5 day) __ Soluble BOD (5 day) __ Cyanide __ Fluoride __ Hardness, Total as CaCOs __ Boron iZ6admium __ Calcium, as CaCOs __ Vanadium -iZ^inc I __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca+2 CLP -1 __ Dissolved Oxygen __ Total Organic Carbon __ Total Organic Halides __ Nitrogen, Nitrate as N __ Nitrogen, Nitrite as N __ Nitrogen, Total Kjeldahl as N _t;;Chrorn!urn, Total __ Chromium, Hexavalent ii^obalt _ Metais/CN- __ Volatiles __ Serni-violatiles *1 ■ ■ __ Solids, Percent (%) __ Solids, Settleable __ Oil and Grease __ Phenol .iZ^opper jXon __ Pesticides/PCB's

TCLP ■ __ Solids, Suspended __ Phosphorus Total as P ! «:«Hi __TCLP-Metals __ Solids, Total _ Phosphorus, Ortho as P __ Magnesium _TCLP-P8sticides __ Solids, Total Dissolved __ Sulfates _ifManganese __TCLP-Herbicides __ Solids, Total Volatile __ Surfactants .jZ^ercury _ TCLP-Volatiles Other: A___________ _ UV254 jZfelybdenum ___ TCLP-BNA’s -ZNickel __ NYC-WTC_000073618