Chain of Custody Record, Sample AE03802, Feb 2002

NYC 9/11 Public Portal Document

I* slcr ENVITONMENTA! SFP75CFS sample SUOVISSION form Mi ■■ 1^? I \A'( Hti WESTCHESTER COUNTY LABOR/VfORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10695 (914)231-1620 Fax (914) 231-1772 tj * ■

NYS-FLAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type •^r. Potable 3. Non Potable Treated Bottle #'s; ' - -___ ...___... ■ 2. Non Potable 4. Other Chain of Custody?___ Yes No SIB •■Bl Time/Date Collected: lilllil Comments: Collected By: Agency Code: Source iD: Type Descriptor:

■I Collected From: Biii to: Location’s/lndividual’s Name______ ........._________ Name/Company Street ___(____ ____ __ )____ i_______ ____ _____ : Street_________ C- ' ■__ ____ L_________ / Cl City'StT’iP ... ■ Identification of Source________________ _ _________ PSione#: Fax#:^ Colieclion Point _ ___ _ _______________ ___ _________ _ 1 CA,CH, Bl? Check#: j Amount$_j ___

BAC TERIOLOGiCAL ANALYSIS Lab#: Lab#:______________________ ____ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTAOLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalornethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & al! others) _r^olatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _-Volatiie Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (ail samples) __ Total Trihalomethane Potential (510) __ Orqanochlorine Pesticides (608/8081) __ Microscopic __ Microextractabies (504) _ PCB's (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,8151) __ PCB as Decachlorobiphenyl (508A) _ other Pesticides (SMI8/6630) _ API __ 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) __ Diquat (549) .i_ GC/MS Unknown Scan Free Chlorine Res: mg/L __ Chlorination Disinfection Byproducts (551) ___ Phthalates (606MS) B Total Chlorine Res:mg/L Haloacetic Acids (552) _ Other: . Other Pesticides (SMI8/6630) pH ____ __ _ UCMR List 1 RAOIOCHEWUCAL ANALYSIS MtBE Only (524) ---------- --------- — ___ Radon __ Other_______________ _ ■ . iNORGANiC ANALYSIS REQUESTED - __ Color __ Acidity * 122 Aluminum; __ Potassium __ Turbidity __ Alkalinity Antimony .-'Selenium pH Conductivity „ Corrosivity (temp: “C) __ Bromide __ Bromate/Chlorate/Chlorite: ..•..■Arsenic Barium K’^ilver __ Sodium I ... BOD (5 day) _ Carbonaceous BOD (5 day) __ Chloride __ Cyanide __ Fluoride SIS ._j_ Beryllium __ Boron .iYCadrnium _irYhailium __ Vanadium C'Zfhc ■I Ml1 „ Soluble BOD (5 day) __ Chemical Oxygen Demand __ Hardness, Total as CaCOa __ Nitrogen, Ammonia as N __ Calcium, as CaCO.i __ Calcium, Ca« ■ _ Metals/CN __ Dissolved Oxygen __ Total Organic Carbon Total Organic Halides __ Nitrogen, Nitrate as N __ Nitrogen, Nitrite as N __ Nitrogen, Total Kjeldahl as N Chromium, Total __ Chromium, Hexavalent .^■Cobalt __ Volatiles __ Semi-violatiles __ Pesticides/PCB's i __ Solids, Percent (%) __ Solids, Settleable __ Oil and Grease Copper IB __ Phenol . -Iron T£L£ Solids, Suspended __ Phosphorus Total as P _._rLead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides Solids, Total Dissolved __ Sulfates t-Manqanese _TCLP-Herbicides __ Solids, Total Volatile _ Surfactants _i.Mercury TCLP-Volatiles _".-"Other;■ ’• : _ UV254 i-'Moiybdenum ___ TCLP-BNAs _.^Nickel

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