Chain of Custody Record, Sample AE03822, Feb 2002

NYC 9/11 Public Portal Document . ■’ 7;., .-’■•it’ •> 'A-; "• f- ■ *•>

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH '2 Dana Road, Valhalla, New York 10595 b " r/fielant I

r (914)231-1620. Fax (914) 231-1772 . , I NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01) (

i’ Sampje Type (circle one): L. '<r r/-z-A, & -1. Potable 3. Non Potable Treated Bottle #’s: "Z/Non Potable 4. Other Chain of Custody?Yes No' ; Time/bate Collected: ____ / 2? 6? Z 7____ i-i—£. Comments: TTTA a < “ ■ / “ Collected By: f z.Yv.. .' T- '" ■ Agency Code: PWS#:_______ 2 Source ID: Type Descriptor:".: , ■■ *.

Collected From: Bill to: ■■ "vF

.Location’s/lndividual’s Name - Name/Companyf fe . Street -_______ __________ Street P tv City/St/Zip_____ Citv/St/Zip~ 1

S'S." Identification of Source . ./Collection Point _ <r'o^-z <0 Phone#:

CA,CH, Bl? ' 77 Check#?- f- ' 2; Fax#:

■ . ^Amounts r P- BACTERIOLOGICAL ANALYSIS Lab#: I-' A/ ■ AAA"'I'- A/ ...'- -- ''■'A...- a; r J 'A ■ ’ J:/"' /’A ' Gb#: ___________ ORGANIC POTABLE ANALYSIS T ORGANIC NONPOTABLE/SOLId XnALYSIS JY Heterotrophic Plate Count ■ .(hemodialysis & all others) - __ Trihalomethanes (524) __ Volatile Halocarbons (524) . Purgeable Halocarbons (624/8260) ' " _2 Purgeable'Aromatics (624/8'260) A .• *’ i I' __ Coliform P/A (Public supplies) ‘ ;_ Coliform MPN (priv well, raw, stp) 12.-Fecal Coliform (all samples) Ci Microscopic __ Volatile Aromatics' (524) ’■3“ 1

Total Trihalomethane'Potential (510) _ MicroextractabTes (504) --L/Acrolein a^Aci^onitrire'''(8260).,^ / - ; _i’‘OrgaripchjorineAesticideA(608/808l jc •. ; PCB’S (Arochlors) 4608/8081) ' ' I ■I .i __ Macroscopic ' ■ ■< __ Pesticides/pCB screen (508) ^■Herbicides (SM18/6630,8151)'F,</s y " * ■ i fen 2^'API ; C- . • PCB as Decachiorobiphenyl (508A) _AOther'Pesticicies;-(^M18/6^0) A’ Ai )

I- 'li. other:C- Ti t .. ■ ?' • Refrigerated? -i-yes 7 ”i~’ • nd _ Herbicides (515) __ Pesticides (525) ?

__ Carbamate Pesticides (531) _ /Petroleum Hydrocarbon Scan " (31043)“ ’Glycols'in Water,' ? ■ - A ’Acid'Ejrtractabies .(62'5/8270) i f a V * Z’

Chlorinated:? .yes no _Glyphosate (547)''^ f Neutral Extractables/(625/827TI) ) _.piquat (549) J/^C/MS Unknown Bean U • Free Chlorine Res:______ l_ mg/L _JChl6rination Disinfection Byproducts (551) _ Phthalates4606MS)' " Total Chlorine Res:_______ mg/L _ Haloacetic Acids (552) _ .Other:£ __ Other Pesticides (SMI8/6630) U--. Y-, I -pH/'.? . - J rJ ■ TjUCMRList T ' .r ■3 ■?

p . , "'Z

I / RADIOCHEMICAL ANALYSIS Radon i? " _r Other ■ ’ - _ MtBE Only (524) ■I '■

„7>TJ A'/,"' ■' (J-''--™ •<

.INORGANIC ANALYSIS REQUESTED- Lab#: T- _L’Color '. . ' __ Acidity tA Aluminum '’■A./T',.,. Potassium > , - •i ¥- Turbidity _ pH‘ J.__ Alkalinity -J- Bromide ' ’ , 1_ Antirpony'\ Arsenic ...) _/Selenium" ■‘-ii. ^Silver.;!:"' ajU U# A

J- Conductivity '■' t- _i_ Bromate/Chlorate/Chlorite ’4_ Barium' / fe-- ^-Sodium}-- ..M: * _ Corrosivity (temp°C) _ BOD (5 day) "__ Carbonaceous BOD (5 day) J_ Chloride -__ Cyanide £2. Fluoride , '\ ' ' Beryllium/- ?- Boron X - __ Cadmium ■IT jCThalliurn ^7/ ‘ .YlAs . iYyahadidm L-IZ T ' *■ . 83 Soluble BOD (5 day) - __ Hardness, Total as CaCOs Calcium, as CaCOs -Jr .f, .vC J'

K Chemical Oxygen Demand __ Nitrogen, Ammonia as N Caiciurn’, Ca*^' ,,' .7 ■clF''“T~“~~ _ Metals/CN ’ ■? ” r 7 ‘

I _ Dissolved Oxygen ■ 2_ Nitrogen, Nitrate as N, ..... • Total i _Chromium', — ,. .F, _Volatile<x m ' __ Total Organic Carbon __ Nitrogen, Nitrite as N ' " Chromium, Hexavalent - __ .Total Organic Halides __ Solids, Percent (%) Nitrogen, Total Kjeldahl as N _OilandGrease Cobalt ___ Copper \ Semi-violatiles ■' '_'Pesticides/PCB's ■ ! 1 "__'' Solids, Settleable .■__ Phenol A '" ‘ Tj; Iron / lALead.,../;. tCLE ' c , / '1 :__ Solids, Suspended __ Phosphorus Total as P I .__ Solids, Total _ ; Phosphorus, Ortho as P Magnesium'-" _TCLP-Metals .f J /

F _ Solids, Total Dissolved __ Solids,'Total Volatile ' Sulfates' TA Surfactants , ’■'A?* __ Mariganese \ Mercury I __ TCLP-Pesticidesv ’ . _TCLPrHerbicides<'’ < J I __ Other: _ UV254 - 4 L 'i. W Ji. Molybdenum Nickel . Y’ -7. _ TCLP-Volatiles ' . _ TOLP-BNAs' :

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NYC-WTC_000073871