Chain of Custody Record, Sample AE03802, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster I I:\:cc!ii WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 ■ I NYS CLAP N-. ’0 !08 Time/Date Set: /.orm A-70 (rev. 10/01)

Sample Type 1. Potable 3. Non Potable Treated ■ SI .' 2. Non Potable 4. Other: Chain of Custody?Yes No . h-. / ■:: 1 Time/Date Collected:^: CornineiUs: P- ..... ' . .. . . ? Agency Code: PWS #:_______ Source ID: _,Type Descriptor: ■ Collected f rom: Bill to; Location's/lndividual's Name Name/Company Street_______ _ __________ _ Street________ _ City/St/Zip_______________ _ Identification of Source City/St/Zip Phone#: J Fax#: : ■ Collection Point j CA.CH, Bl? Check#: Amourit$„ I EACIERiOLOGiCAL ANALYSIS Lab#:_______________________ Lab#: I ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS 11 __ Heterotrophic Plate Count IB (hemodialysis & ail others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) __ Volatile Halocarbons (524) IB __ Coliform P/A (Public supplies) __ Purgeable Aromatics (624/8260) __ Coliform MPN (priv well, raw. stp) __ Volatile Aromatics (524) Acrolein & Acrylonitrile (8260) __ Fecal Coliform (ail samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic Macroscopic __ Microexiractables (504) __ Pesticides/PCB screen (508) _ PCB’s (Arochlors) (608/8081) Herbicides (SMI8/6630,8151) 1 API __ PCS as Decachlorobiphenyl (508A) __ Other Pesticides (SMI8/6630) __ Other:_______________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) #0 __ Pesticides (525) __ Glycols in Water Refrigerated?yes Chlorinated:?yes no no __ Carbamate Pesticides (531) __ Glyphosate (547) _ Acid Extractables (625/8270) __ Base Neutral Extractables (625/8270) ■ II: __ Diquat (549) <1. GC/MS Unknown Scan Free Chlorine Res:____ : . mg/L: __ Chlorination Disinfection Byproducts (551) . Phthalates (606MS) is Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ Other:______________ ______ ..._____ _ ______ _ Other Pesticides (SM18/6630) pH _____________ „_UCMRList1 RADIOCHEMICAL ANALYSIS ___ MtBE Only (524) ___ Radon __ Other; ■

INORGANIC ANAS.YSIS REQUESTED - i .Mr __ Color __ Acidity __ Aluminum • __ Potassium Turbidity __ Alkalinity __ Antimony _ Selenium _ pH __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium __ Sodium __ Corrosivity (temp: .’C): __ Chloride __ Beryllium __ Thallium _ BOD (5 day) __Carbonaceous BOD (5 day) __ Cyanide __ Fluoride __ Boron __ Cadmium __ Vanadium _ Zinc ■ „ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCO; __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca« _ Metals/CN 1 __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles I __ Total Organic Carbon Total Organic Halides __ Nitrogen. Nitrite as N __ Nitrogen, Total Kjeldahl as N __ Chromium, Hexavalent __ Cobalt __ Semi-violatiles a II _ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease __ Copper __ Solids, Settleabie __ Phenol __ Iron JCl.P __ Solids, Suspended __ Phosphorus Total as P __ Lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium „ TCLP-Pesticides

I■ _ Solids, Total Dissolved __ Sulfates __ Manganese „ TCLP-Herbicides ___ Solids, Total Volatile __ Surfactants __ Mercury _ TCLP-Volatiles __ Other:___________________ UV254 __ Molybdenum _ TCLP-BNAs __ Nickel MB NYC-WTC_000073848