Chain of Custody Record, Sample AE03798, Feb 2002

NYC 9/11 Public Portal Document Hi ■ Ilw-ifSSW ENVIRONMENTAL SERVICES SAMPLE SUBMISSiON FORM

Fl \A'( ’ill WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 I ’’NYS-ELAP No. 10108 Time/Date Set; a fYi5~ (J sd Form A-70 (rev. 10/01)

Sample Type :i.: vij’oteble 3. Non Potable Treated Botlle «'s: Z. Jf •r z i p J 2. Non Potable ■4. Other; Chain of Custody? Yes___ No; z Pk;- ■ Time/Date Collected: z IM rC Coniinonts: ■ Collected By: L ' T ' Agency Code:____ , PWS #:, Source ID: _Type Descriptor:i I Collected From- Bill to; I IP LocationY/indivif'cal’s Name Street j HpS ..f’ ’ y ‘... Y-;P< O; , Name/Company _ Street__________ ■ s 1 City/St/Zip V P» i iW i i\ . __ ZJpJjS,

■I C4y'S?.'7ir Identification of Source l Phone#:___ _ __ Fax#:; CiPI-vuoi; Point . '■; ___________________ CA.CH, Bl? Check#:- Amounts 1 BACTERIOLOGICAL ANALYSIS Lab#:; I Lab#:__________________________ __ Heterotrophic Plate Count ORGANIC POTABLE ANA!,YSIS __ Whalomethanes (524) ORGANIC NONPOTABLE/SOL ID ANALYSIS ■ (hemodialysis & ail others) ....„ Purgeable Halocarbons (624/8260) __ Coliform P/A (Public supplies) Halocarbons (524) __ Purgeable Aromatics (624/8260) ■1: __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (ail samples) _j^olatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Acrolein & Acrylonitrile (8260) __ Organochiorine Pesticides (608/8081) I __ 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)

Refrigerated?____ yes no no __ Pesticides (525) __ Carbamate Pesticides (531) __ Glyphosate (547) Glycols in Water Acid Extractables (625/8270) ase Neutral Extractables (625/8270) I ■I Chlorinated:?____ yes _..... Diquat (549.) C/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 (SMI 8/6630) pH___________ _ _ UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBE Only (524) ___ Radon . Other J 1 INORGANIC ANALYSIS REQUESTED - i.ab/7 __ Color __ Aridity /■ / C

_i^uminum __ ^tassium 4 __ Turbidity __ Alkalinity _sz^timony _kZ^lenium pH __ Bromide -iBiver

1 ..YfArsenic __ Conductivity __ Bromate/Chiorate/Chlorite _t?6arium __ Sodium __ Corrosivity (temp: .“C) __ Chloride _w?6eryllium _i/fhallium .... POD (6 ilaV, Carbonaceous BOD (5 day)- __ Cyanide __ Fluoride __ Boron j^adrnium __ yanadium --r^Zinc I __ Soluble BOD (5 day) __ Chemical Oxygen Demand __ Hardness, Total as CaCOs __ Nitrogen, Ammonia as N __ Calcium, as CaCO:! __ Calcium, Ca« "CLP I __ Dissolved Oxygen _ Total Organic Carbon Niiiogon. Nilrnle ns N __ Nitrogen, Nitrite as N _i^Chromium, Total __ Chromium, Hexavalent „ Metals/CN _ Volatiles 1 __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N vGoiutlt __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease .iCOLper __ Solids, Settleable i'huiiol z-tfon TCLP __ Solids, Suspended __ Phosphorus Total as P .j,Xead _..TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P gnesium _ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates inese „_TCLP-Herbicides __ _Solids, Total Volatile __ Surfactants iZ’ other: ________ - „ TCLP-Volatiies „ UV254 _4,^-4Violybdenum _ TCLP-BNAs

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