Chain of Custody Record, Samples AE03434/3454, Feb 2002

NYC 9/11 Public Portal Document

V1* A C C 0 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM -Westchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 I o/ ■ 5 (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 time/Date Set: '4 f - L) !> >i - Form A;70 (rev.10/01)

Sample Type (circle one): '■ * } rn ■ T Potable 3. Non Potable Treated Bottle #'s: > * V -1 : - ■ ■LI 2. Non Potable 4. Other Chain of Custody?Yes No ! Comments:___________________ Time/Date Collected: ■ s Collected By: t W Agency Code: PWS #: Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street_________________ Street________ City/St/Zip______________ City/St/Zip Identification of Source Phone#: Fax#: I Collection Point CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#: 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) __ 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 (SM18/6630,8151) ) API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI8/6630) _ Other:____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water Refrigerated? yes no __ Carbamate Pesticides (531) __ Acid Extractables (625/8270) I Chlorinated:? yes no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) _ Diquat (549) ^--GC/MS Unknown Scan 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 __________ __ UCMR List 1 ; RADIOCHEMICAL ANALYSIS _MtBEOnly (524) __ Radon ’ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity _C''Aluminum __ Potassium j _ _ Turbidity __ Alkalinity AifAntimony Selenium _ pH __ Bromide .i_/Arsenic J:2"Silver __ Conductivity __ Bromate/Chlorate/Chlorite i/Barium __ Sodium )__ Corrosivity (temp:. ’C) __ Chloride ^•'Beryllium Thallium 1' . BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium __ Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs CLP ‘__ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 _ Metals/CN (__Dissolved Oxygen __ Nitrogen, Nitrate as N __;Chromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N 2>Chromium, Hexavalent __ Semi-violatiles ;__ Total Organic Halides __ Nitrogen, Total Kjeldahl as N Cobalt __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease Copper __ Solids, Settleable __ Phenol ..■2_ Iron TCLP __ Solids, Suspended __ Phosphorus Total as P Lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides _ _ Solids, Total Dissolved __ Sulfates __ Manganese __ TCLP-Herbicides Solids, Total Volatile __ Surfactants _ : Mercury _TCLP-Volatiles - / Other: w.. UV254 __L Molybdenum _ TCLP-BNA’s __ Nickel

NYC-WTC_000073683