Chain of Custody Record, Sample AE03822, Feb 2002

NYC 9/11 Public Portal Document

. ‘i ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH. 2 Dana Road, Valhalla, New York 10595

I. (914)231-1620 Fax (914)231-1772 ’ I.. NYS-ELAR No. 10108 j Time/Date Set: -3 " . * I. Forrn A-70 (rev. 10/01) Y j r k Sample Type'(circle one): •Y potable ' ’ 3. Non Potable Treated Bottle #’s: CS-Z.S Yes'. No’ 1 Z Non Potable 4. Other - Chain of Custody? I' Time/Date Collected: S' ■ Comments: ' b d 'Collected By:- ''k» > i *5 /d Y Yy vAgencv Code: PWS : Source ID: Type Descriptor: __k

I Collected From: ' Locatio'n’s/lndividual's Name 3 'Street _i____________________

• City/St/Zip__________________ Bill to: Name/Company Street - ■iSSS.- City/SVZip r ‘

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K' i* Identification of Source Phone#: J vti E lFax#:'i "If -,"Collection Point r- CA,CH, Bl? - Check#: Amounts^

E BACTERIOLOGICAL ANALYSIS Lab#: - ■ ' Lab#:t _

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ORGANIC POTABLE ANALYSIS I . * ORGANIC NONPOTABLE/SOLID ANALYSIS -; ___ Heterotrophic Plate Count s __ Trihalomethanes (524) k_‘ F’urgeable Halocarbons’'(62-4/8260) ’ ,Y, - (herriodialysis & all others) t- fei Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Volatile Aromatics (524) ' ;_ 2 Purgeable Arorriatics,'(624/8260) *' * ’__ ' Acrolein & Acryionilrile ■(8260) i ’ - ; -k' -k

■kL Coliforrh MPN '(privwell, raw, stp) Si. s __ Total Tri’haiomethane Potential (510) . ' ■ ’Orga'ndchldririe Pesticides (608/8081);'' Fecal Coliform (all samples) __ Micrbextractables"(504) - _k PCB’s (ArdchlorsneOS/sbsifj v __"Microscdpic " ‘ ' ■/_ Pesticides/PCB screen (508) ■ 21 fHerbicides (SM 18/6630,8151), xv 2 ‘

t. ' Macroscopic APik- ‘__ Other: ’ ■ ' . - __ ______ __ PCB as Decachlorobiphenyl (508A) __ Herbicides (515) - ■. • " 2; other Pesticidesi'XSM 18/6630)' t-"" Petroleum Hydrocarbon Scan (316^13) . '**» _ Pesticides (525) Glycois in Water ‘ k d 2; YY. . ■' "• Refrigerated? 2 yes_ _ no __ Carbamate Pesticides (531) ’k-'Acid Extractables.(625/8270) Y--' ’

I- Chlorinated:?____ yes____ no ’Y ■EwV'W'-' “ Free Chlorine Res: • A mg/L __ Glyphosate'(547) _ Diquat j549), __.Chlorination Disinfection Byproducts '(551) ■ 'tk ^ase: Neutral Eidractables’(6^/8279); ' ' ,'kYGC/MS Unknown Scan' ' _ Ptithalates’(606rvlS)Y ‘ ’ ■ 'f J'•- • Y Y Y

Total Chlorine Res: -• mg/L __ HaloaceticAcids (552) / ■' Oth’er;__jd_2___l__£_^____2dd2_2__ _ Other Pesticides (SMI 8/6630) . □ I .-.r-., ' t _UCMRListT ---------- —Xy K- . RADIOCHEMICAL ANALYSIS • _ MtBE Only'(524) ' 3 t.

A—r -Y""— . '■'k •J ( h■ _Radon.'.'■ { 2 Other Y_^__________ _ -

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k ■ INORGANIC ANALYSIS REQUESTED - Lab#: ''__Color __ ‘Turbidity. •i 'vA __ Acidity ./ r__ ^■’Alkalinity v/Aluminum •| -Antimony t (Y LufSeienium ’ .__ Potassium"

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.1--(^Silver , ■ . pH . Bromide t i;£ Arsenic E ___Conductivity _. Corrosivity (temp:. .“’C)’ __ Bromate/Chlorate/Chlorite Chloride ' . Barium □-/'Beryllium Lk Sodium-Skv '"^<rhalliun?BW^^ W' t -—/ BOD (5 day) rkk^Carbonaceous BOD (5 day) > ___ Cy’anide _L Fluoride ■ • . - — Boron J_ Cadmium '''‘<Yi Vanadidm Y, Y r3«/ Tf-. i-^inc'* 'I

I ------ - ,T»k ... -1 iJL'Soluble b6d.,(5 day) . * __ Hardness;Total as CaCOs __ Calcium,'as CaCOa. £LP-Y'.;r- Ji Chemical Oxygen Demand ,__ Nitrogen, Ammonia as N __ Calcium,'Ca+2.. □_ MetalsfcN ' 1 '__ Dissolved Oxygen Nitrogen, Nitrate as N lil'Chromium, Total

I' '__ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium', Hexavalent k' • i_ Volatiles'' 'i Semi-violatiles ■ __ Total Organic Halides _ Nitrogen, Total Kjeldahl as N iz Cobalt ' , X f/k Pesticides/PCB’s __ Solids; Percent (%) Oil'and Grease • j^ Coppef * '. . _ Solids, Settleabie __ _ Phenol -izlron ■ ' . ' ' . TCLP __ Solids,-Suspended __ Phosphorus Total as P ikLead >' - ‘ ' •>. -' v;;. :_iTCLP-Metals. _ Solids, Total __ Phosphorus, Ortho as P __ Magnesium 'k__ TCLP^Pestici'des F" __ Solids, Total Dissolved _□ Solids, Total Volatile __ Sulfates ’ __ Surfactants ’ i^Manganese > Mercury tCLP-Herbicides fc *±k''Other: k . _ UV254 ^'Molybdenum TCLP-Volatiles )> TCLP-BNA’s k - 2/Nickel

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