Chain of Custody Record, Sample AE03388, Feb 2002

NYC 9/11 Public Portal Document

( ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Of I I-* (914)231-1620 Fax (914) 231-1772 < LAJUmIEmnsMJ X NYS-ELAPNo. 10108 Time/Date Set: Form A-70 ^rev.10/01)

Sample Jype (circle one): tv) Bottle #'s: ___________ A 1 ■ Potabjy 3. Non Potable Treated 2. Non Potable 4. Other Chain of Custody?___ Yes No- Time/Date Collected: / Comments; Collected By: _ Agency Code: PWS #:______ Source ID: Type Descriptor: Collected From: Bill to: Location's/lndividual’s Name N M _____________ Name/Company Street / j C. P f £>'’(' ‘_ Street_______ City/St/Zip ' Ji/1 yOS ? S City/St/Zip Identification of Source___________ Ld_____________________ Phone#: Fax#: Collection Point_____ ■' > Z _________________________ CA,CH. Bl? Check#: Amounts. !

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) (hemodialysis & all others) __ Purgeable Halocarbons (624/8260) Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) Volatile Aromatics (524) __ Acrolein .& Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) _ .PCB’s (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8l51) _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI 8/6630) __ Other:_____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) Pesticides (525) __ Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) Chlorinated:?yes no __ Glyphosate (547) __ Base Neutral Extractables, (625/8270) _i<GC7MS __ Diquat Unknown Scan '* (549) Free Chlorine Res; . mg/L __ Chlorination Disinfection Byproducts (551) ■ __ Phthalates (606MS) Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ Other:, _ Other Pesticides (SM18/6630) pH ___________ _UCMRList 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon _ Other____________________ % INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Aridity - ±:^luminum ■ Potassium __ Turbidity __ Alkalinity ^Antimony _tr-SiBlenium - _ pH __ Bromide j-rArsenic JrSilver , __ Conductivity __ Bromate/Chlorate/Chlorite _irBarium Sodium ..z __ Corrosivity (temp:. .“C) _ Chloride _i-Beryllium ' _YTRaliium _ BOD (5 day) __ Cyanide __ Boron __ Carbonaceous BOD (5 day) - Fluoride _jJSadmium _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand _ Nitrogen, Ammonia as N __ Calcium, Ca'*^ GLE ; 1 _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N _uGhromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N _4f€dbalt __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease _^opper __ Solids, Settleable __ Phenol _i^lron __ Solids, Suspended __ Phosphorus Total as P zU-ead T.CLP _TeLP-Metals __ Solids, Total __ Phosphorus. Ortho as P __ Magnesium . . TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates _iir*Wanganese _TCLP-Herbicides _ Solids, TotaLVolatile __ Surfactants -HVIercurv __ TCLPAVolatites ; >Other: __________ _ UV254 _M51olybdenum _ TCLP-BNA’s _Mckel

NYC-WTC_000073664