Chain of custody record, Westchester County Labs, Feb 2002

NYC 9/11 Public Portal Document

ACCg, ENVIRONMENTAL SERVICES SAMPLE SUBMiSSiON FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 1Wt MIL 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 uL._.. .J NYS-EtAPNo, 10108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type (circle one):- 2272 q-2-7*1 3. Non Potable Treated 2. Non Potable Time/Date Collected: 4, Other______________ Z...- J Chain of Custody?Yes Coiisinenss. .. No 1 Bi Collected By: /„ Uc' Qy Agency Code:___ : PWS #:_______ _ Source ID: Type Descriptor: CoiiccTed From: Bill to: Location’s/individual's Name M V C. ft ______ : Name/Company i Street .. _______________ _ Street: Citvzsvzip Vc-tb''■_____ ftY__ 1.............i/c City/SVZip: Identification of Source__ _____________________________ : Phone#:... ......... , Fax#: Collection Point, A I-1__________ CA.CH, Bl?: Check#:: Amounts

BACTERIOLOGICAL ANALYSIS Lab#:’ Lab#:__________________________ : --------- ORGANIC POTABLE ANALYSIS ORGANIC NONFOTARLF/ SOLiD ANALYSIS __ Heterotrophic Plate Count (hemodialysis & al! others) __ T/ihalomethanes (524) __ Purgeable Halocarbons (624/8260) ft __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) i^wolatile Halocarbons (524) jiZvolatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Purgeable Aromatics (624/8260) __ Acrolein & Acrylonitrile (8250) ■Uli __ Orqanochlorine Pesticides (608/8081) Btim IB I __ Microscopic __ Microextractables (504) _ PCB's (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) Herbicides (SM18/6630,8151) ■■■I BlBlIillllllllllB __other:______ ___________ _ _ PCB as DecachlbroblpKenyl (508A) __ Herbicides (515) i Other Pesticides (SMI8/6630) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water lisi Refrigerated?____ yes____ no Chlorinated:?: Free Chlorine Res:__ : yes. no . mg/L: __ Carbamate Pesticides (531) __ Glyphosate (547) _ Diquat (549) __ Acid Extractables (625/8270) __ Base Neutral Extractables (625/8270) i./GC/MS Unknown Scan . ■ft __ Chlorination Disinfection Byproducts (551) Phthalates (606MS) Total-Chlorine Res: mg/L __ Haloacetic Acids (552) -------------------------------------- _ Other Pesticides (SM 18/6630) pH ----------------------

RADIOCHEMICAL ANALYSIS i------ ----------------- ___ Radon __ Other_______________________ __________ I■ INORGANIC ANALYSIS REQUESTED - Lab#: __ Color . __ Acidity Juminum I __ Turbidity _ pH Conductivity __ Alkalinity __ Bromide __ Bromate/Chlorate/Chlorite JiTAi.ntimony j'senic ^rium Silver __ Sodium - I __ Corrosivity (temp;; __ BOD (5 day) __ Carbonaceous BOD (5 day) .“C): __ Chloride __ Cyanide __ Fluoride ieryllium __ Boron _i><;admium x^Tfiallium __ Vanadium _^nc I __ Soluble BOD (5 day) __ Chemical Oxygen Demand __ Hardness, Total as CaCOts __ Nitrogen, Ammonia as N __ Calcium, as CuCOo __ Gaicium, Ca« CLP _ Metals/CN ■ i __ Dissolved Oxygen Total Organic Carbon __ Nitrogen, Nitrate as N __ Nitrogen. Nitrite as N jiZChromium, Total __ Chromium, Hexavalent Volatiles __ Semi-violatiies Ml ■ I __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N _±=2Cobalt __ Pesticides/PCB's Solids, Percent (%) __ Oil and Grease ._t<9pper Solids, Settleable __ Phenol Y,-’j^n TCi..P ■li: __ Solids, Suspended __ Phosphorus Total as P j.i-'Lead __ Solids, Total __ Solids, Total Dissolved __ Phosphorus, Ortho as P __ Sulfates __ K^gnesium _ii:-1^nganese „TCLP-Metals __ TCLP-Pesticides TCLP-Herbicides i Solids, Total Volatile __ Surfactants Jk-M^rcury __ TCLP-Volatiies vz'fether: ______ : _ UV254 i^4SMybdenum TClPBNAs _ :-Nickel

NYC-WTC_000073620