Chain of Custody Record, Sample AE03822, Feb 2002

NYC 9/11 Public Portal Document J •1

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM I gASfetehester ' WESTCHESTER COUNTY LABORATORIES AND RESEARCH i

2 Dana Road, Valhalla, New York 10595 , 1 it’ I S^' ■ (914)231-1620 Fax (914) 231-1772,\ ‘ J / NYS-ELAP No. 10108' f Time/Date Set: Form'A-70 (rev.10/0'l)

s/TSample Type (circle one): 7~~~7F~7 ,4 '■ '• ’ t>.

4.'Potable^) 3. Non Potable Treated Bottle #’s: ' Y ■

2. Non Potable 4. Other ___________ Chain of Custody? Yes _ No

I Time/Date Collected: > ' - Comments: Collected By: Agency Code: PWS #:__________ Source ID: ‘ Type Descriptor: ■ ■v 'I f * ■ ■ ., - I Collected From: "’Location’s/lndividual's Name '. , Bill to: Name/Company;1 ■ ’ i

tb Street ■ _________ 1 ‘.City/St/Zip____________ 7 Street________77 City/St/Zip ' 4: 'Identification of Source' ' ’ Phone#: v. Y '•P is Fax#: i.

I .^Collection Point■ 3 74 riU CA,CH, Bl?^ TL Check#: ■' ’ Amounts

E BACTERIOLOGICAL ANALYSIS. ? Lab#:' '' 4. Lab#: ■ r 1X ' <3 -n 7 ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/ SOLID ANALYSIS -Y Heterotrophic Plate Count V __ Trihalomethanes (524) ,7 ^Purgeable Halocarbons '"(624/8260) . ’’ 7 . >; (herhodialysis Sail others)

feh __ Volatile Halocarbons (524) ' ’ Coliform P/A (Public supplies) Coliform MPN ‘(priv well, raw. stp) _ Volatile Aromatics (524) 7 Total Trihalomethane Potential (510) ■ ' Purgeable Aromatics. (624/8260) '7 ’ 7' Acrolein &’Acrylcmitrile 'j(8260) " ' ■ ? ' *. Organochiorine Pesticides ‘ (608/8081) 3 __ Fecal, Coliform (all samples) X’Microscopic __ Microextractables (504) H fPCB’e (Arochlors)-’(608^081 )■' ' 7 Macroscopic __ Pesticides/PCB screen (508) "7‘Herbicides''(SM18/6630,8151) 7'77 __ PCB as becachlorobiphenyl (508A) ^ Other Pesticides ‘(SMI8/6630)'’ - - "7

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■ — .other: •__________ _ Herbicides (5'15) ' __ ’Petroleum Hydrocarbop Scan,, (310;13)' -? ! r _ Pesticides" (525) . - ' ? • 7'Glycols in Water *’■" ’ "Y ' Y ’ 7^'" . Refrigerated? ;yes no . __ Carbamate Pesticides (531)' ’ / " 7 *AcicfExtractabies (625/8270)?. " <7'7 7' no 7 '__ Glyphosate (547) - 7'’ease Neutral Extractables (625/8270) > ' J, . Chlorinated:? ' -yes Free Chlorine Res; . mg/L 7Diquat (549) . tXc/MS Unknown Scan?7 , " -.

I ___ Chlorination Disinfection Byproducts (551) ,7’Phthalates (606MS) '”'1,., L ■fotai.Chlorine Res: - mg/L' __ Haloacetic Acids (552) ■ 7 'Other:_7_7___7L_______77 pH .77X__1.‘7’.’ _ Other Pesticides (SMI8/6630) P_UCMRList1

I’ RADIOCHEMICAL ANALYSIS vRadon ' f _MtBE'Only (524) i ^7 :f pother J I;" INORGANIC ANALYSIS REQUESTED - Lab#: - .-5' ' . ■ -• ' - - >A'-

_ Color' ,, '■; ’■ __ Acidity ,' r ' < ■. ” '- Y - 67'75. _Aluminum ■ < ' .L_ Potassium' " , ■;_j/Turtiidity ”.__ Alkalinity, ,/Y'Antimony ' 'W ...YXSelenkirf^. 17 •__ pH' .__ Bromide ’ z' Arsenic M- . 7- Conductivity s., _ . ' . __ Bromate/Chlorate/Chlorite , Barium ' , 'Corrosivity (temp: ' °Ci __ Chloride ^Beryllium • .7 ' ^‘^.,.^Xthallium7Y •- 7^ f _ BOD (5 day) ." _ Carbonaceous: BOD (5 day) - Cyanide _ Fluoride ' . __ Boron __ Cadmium. . 7 7Zinc I . •' , Soluble BOD (5 day) ., ' ' / __ Hardness, Total as CaCOs _ Calcium? as CaCOs clp..y' . .7- . _ Chemical Oxygen Demand _L Nitrogen, Ammonia.as N _,’Calcium,, Ca*7- . ,"1 _ Dissolved Oxygen'- , __ Nitrogen, Nitrate as N ,7Chr6mium, Total , ' 7 Metals/CN ■ , 7 Total Organic Carbon __ Nitrogen, Nitrite^as N __ Volatiles Chromium, Hexavalent 1_ Total Organic Halides •4 _ Semi-violatiles' •„ __ Nitrogen,,Total Kjeldahl as N ._Ac6balt ■ ?

i ___ Solids, Percent (%).., _5 Solids, Settleable 7,. " _ Solids, Suspended " , __ Oil and Grease __ Phenol ’ __ Phosphorus Total as P ,, . ‘"Copper ■ ■Iron’ ■ i _ Pesticides/PCB’s ■

tclp « ■ ' XLead _.TCLP-Metals“ ’ 7; Solids, Total * __ Solids, -Total Dissolved 7 __ Phosphorus, Ortho as P __ Sulfates __ Magnesium \ ! ; __ ^Manganese i! _ TCLP-Pesticides -■ fe- Solids, Total Volatile __ Surfactants _ .‘Mercury T! _TCLP-Herbicides „

r. _ TCLP-Volatiles •4 Tother: ’ -5^4^- _ UV254 Molybdenum' 4. __ TCLP-BNA's ‘ ' ..^Nickel T» * • ' • z

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