Chain of Custody Record, Sample AE03822, Feb 2002

NYC 9/11 Public Portal Document t*.

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ' J WESTCHESTER COUNTY LABORATORIES AND RESEARCH s 2 Dana Road, Valhalla, New York 10595 i O / ■ H (914) 231-1620'Fax (914)'231-1772 ’j* : NYS-ELAPNo. 10108 J' Time/Date Set: Form A-70 (rev. 10/01) ' ' I'

Sample Type (circle one): / f?--? zY I Kt' Bottle #’s: _XL___ F 1^1. potable 2. Non Potable ’ ■ 3. Non Potable Treated 4. Other ‘ Chain of Custody? l 'T '

Yesi No F Time/Date Collected: Comments: ,-i*

FI' Collected Bv: ^?' ' A» YY/'tY'aA; r Agency Code: ' PWS #:_________ •• Bill to: -- Source ID: Type Descriptor:

Location’s/lndividual's Name -y" / Name/Company ■ -Fy-'

I Street _ _________ __________________ _Y___________ ' City/StZZip __ _____________ F_______ _F___________ Street City/St/Zip i 4

■' ■ FF.. ~ Identification of Source_______________________________ Y Phone#: ' . I. ' ■’ 'Fax#:

Collection. Point_______ ____________________ -__________ ‘ CA.CH, Bl? Check#:’ Y’, "AmouhtS '

fe' sn BACTERIOLOGICAL ANALYSIS Lab#: y 1 p o-z ' "YyY- ' " .A* e; Lab#: Y "x _________ t. J sr. _ Heterotrophic Plate Count >■ A, 5 ORGANIC POTABLE ANALYSIS/ __ Trihalomethanes . (524) , ’ ORGANIC NONPOTABLE/SOLID ANALYSIS' ■ .Y Purgeabie HalocarbofisY624/8260) , < (hemodialysis & all others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) ’ ” ’ i_i Coliform P/A-(Public supplies) - __ Volatile Aromatics (524) __ f Acrolein's Acrylonitrile (8260) x wv . C l 1 __ I Coliform MPN (priv well, raw, stp) _Y FecaLColiform (all samples)' . __ Total Trihalorfiethane Potential (510) brganochldrine Pesticides (608/8081) YY Microscopic ’ Y ' '' . __ Microextractables (504)" '" ' _ PCB’s (A'rdchlorsp'(608/808lj ' ' W P -Fapi F,, . Macroscopic __ Pesticides/PCB screen (508) __ PCB as Decachlorobiphenyl (508A) ' f ■ _2'Herbicides (SMI8/6630,8151 )'Y Other Pesticides ^(SMJ8/663b)'Y' I •• K? _Yother: <; __ Herbicides (515) ■ ■ " _ ' '_- Petroleum Hydrocarbon Scan - (Ol 0-13) Y ■■ _ Pesticides (525) .^Y' Glycols iiF Water * Y Y y . ' .: /// Ki. 1 Refrigerated?■ yes Yo __ Carbamate Pesticides (531) ■ _-Acid Extractables. (625/8270)" V .. *’ ChJ^inated:? j yes no _ Glyphosate (547) ' , _ Base Neutral Extractables (625/8270)x Y'\ '21 Diquat, (549) - .. ,.Jl,GC/MS Unknown'Scah X. < ' Free Chlorine Res:. mg/L _Chl6rinatioh Disinfection Byproducts (551)r’ _F Phthalates (606MS); R Total Chlorine Res:_____ ' mg/L 2_‘Haloacetic Acids (552) _Other Pesticides (SM18/6630).' . '■ / 'Y’YY'Y

r8- ■_2 UCMR List I:' ,1 ; ... Y) *’ ■< F Ys RADIOCHEMICAL ANALYSIS Y _ MtBE Only (524) \ ^Ra’don't.- ' .. A- lyc^eY' rY '* "" Y' Y...-. -Ysf ■ S.-V . s' INORGANIC ANALYSIS REQUESTED - Lab#: F ■ YY '..Y-Y'Y' "S-'Y' f ._L Turbidity ■lYi^pl^ ■ . , ’ , ' ■_ - Aridity _Y Alkalinity Bromide r ,

' Ys"Aluminum' 'V'^htimony Arsenic Y* , __ .Potassium'. Selenium 1 (ri ifA - T*" ^Y’'Y.-2vSilver YfOfY" .. " * ’ 1 I- u_£r Conductivity Y-YCdrrosMtv'(temp: _ Bromate/Chlorate/Chlorite - °C), f "__ Chloride ’ •• , J^Barium Ys^Beryllium Y’^’__ r Sodium Y'" .7 A’’ S/ „"_’ BOD (5 day)’-* Y'r _2.- Carbona"ceous BOD (5 day) Cyanide Fluoride . Boron .__ Cadmium / " “ Vanadium"^ v d K Soluble BOD .(5 day) Chemical Oxygen Demand . ■_ : Dissolved Oxygen' & __ Total Organic Carbon _ Hardness, Total as CaCOa 2_ Nitrogen, Ammonia as N ■_SNitrogen, Nitrate as N ' " _ Calcium, as CaCOs __ ,;Calcium„Ca+2 f " j/Chromium, Total , . - : ■ F.'feLpTTr^TJT' Yl_Metals/CN' ’> Y* ■ '__ Volatiles . 4 j ,> __ Nitrogen, Nitrite as N -___ Chromium, Hexavalent __ Total Organic Halides '__ Nitrogen, Total Kjeldahl as N Cobalt , _L Senii-violatiles.-. Solids,'Percent (%) _ Oil and Grease , Y_ Pesticides/PCB’s

I _1 Solids, Settleable •’__ Solids, Suspended __ Solids, Total _ Phenol __ Phosphorus Total as P __ Phosphorus, Ortho as P - Copper _'lron ’ Y^Liead . ' t s ' ■T£LP.;;.'", 'L_TCLP-Metals '■ J _,Magnesium Solids,. Total Dissolved _ Sulfates TCLP-Pesticides .. ■ /Manganese Solids, Total Volatile lLl TCLP-Herbicides __ Surfactants • ' ,■ Mercury AJ-' Other: - _ UV254 . ‘t * Molybdenum. - TCLP-Volatiles K TCLP-BNAs " rYj-Nickelr. '

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