Chain of Custody Record, Sample AE03611, Feb 2002

NYC 9/11 Public Portal Document I.

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ’ ^^estchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. l5lO8 I Time/Date Set: Form A-70 (rev.10/01) I Sample Type (circle one): I 1'Potable) 3. Non Potable Treated Bottle #’s:

2. Non Potable 4. Other Chain of Custody?___ Yes No 1 Time/Date Collected: '' ' Comments: ' Collected By: v ______LJZ Agency Code: PWS #:_______ Source ID: Type Descriptor: I Collected From: Bill to: Location’s/lndividual's Name Name/Company ' Street____________________ street City/St/Zip________________ City/St/Zip Identification of Source Phone#:' Fax#: Collection Point . 5 CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:________________ __________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS t_ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) J (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) ■1__ Coliform P/A (Public supplies) i__ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) I__ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) j__ Microscopic __ Microextractables (504) _ PCB's (Arochlors) (608/8081) ' Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8151) 1 API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) <__ Other:_____________ _ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) t. __ Pesticides (525) __ Glycols in Water i Refrigerated?yes no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) 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 (666MS) " ’ Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ Other:______________________ . _ Other Pesticides (SMI 8/6630) pH _____________ __ UCMR List 1 I RADIOCHEMICAL ANALYSIS _MtBE Only (524) Radon t Other______________________

J INORGANIC ANALYSIS REQUESTED - Lab#: .H !__ Color __ Acidity __ Aluminum __ Potassium ’__ Turbidity' __ Alkalinity __ Antimony ..__ Selenium' pH __ Bromide __ Arsenic '__ Silver '* X f__ Conductivity __ Bromate/Chlorate/Chlorite __ Barium __ 'Sodium ,__ Corrosivity (temp:. °C) __ Chloride __ Be^llium __ .Thallium • sr' _ BOD (5 day) __ Cyanide __ Boron __ Vanadium _ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium __ Zinc , 1__ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 Tlp ,__ Dissolved Oxygen _Metals/CN __ Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles ,__ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles i__ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Cobalt __ Pesticides/PCB's ,__ Solids, Percent (%) __ Oil and Grease __ Copper ,__ Solids, Settleable __ Phenol . __ 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:________ ___________ _ UV254 __ Molybdenum _ TCLP-BNA's __ Nickel

i

NYC-WTC_000073777