Chain of Custody Record, Sample AE03822, Feb 2002

NYC 9/11 Public Portal Document

»»» ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH •t 2 Dana Road, Valhalla, New York 10595 0/1 I

r- - (914)231-1620 Fax (914) 231-1772 'l 4-f ' K' . ’/NYS-ELAP No. 10108 , j , Time/Date Set: "1^. • Form A-1^0.(rev.10/0'1)'J

t" Sample Type (circle one): ' I LT Potablt^ • 3. Non Potable Treafed Bottle #’s:

' 2. Non Potable 4. Other______________________________ Chain of Custody? _ YesBU No fe Time/Date Collected: Collected By; O 't ___________ .2^-1 A \ 2<rLs<>iB» Agency Code: Comments: PWS#:_________ j Source ID:. _Type Descriptor: Collected From: ‘ i Bill to: Location’s/lndividual’s Name_______________________ ___________ Name/Company ■ Street ■ ___________________ Street_________ / •A City/St/Zip___________________________________________________ City/St/Zip J 5 Jderitification of Source Phone#: > " Fax#:

. Collection Point CA,CH, Bl? Check#:’ Amounts.

t BACTERIOLOGICAL ANALYSIS Lab#:" L- .- V.-- -

-Y'r' I Lab#: -______________ A ‘ * 5-^ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS^ Heterotrophic Plate Count. _:_;Pur^abi& Halocarbons J624/8260)’.,, ? ‘__ Trihalomethanes (524) 1 "/hemodialysis &'all others) ' ' ■■ __ Volatile Halocarbons - (524) __ ' Purgeable Aromatics (624/8260) ' ' "J ^.Coliforrn P/A (Public supplies) __ Volatile Aromatics (524) __ i Acrolein & Acrylonitrile (8260) = ' Ef _ Coliforrn MPN (priv well, raw, stp)

I' ’Fecal Coliform (all samples) __ Total .Trihalomethane Potential (510) __ Microextractables (504). ' ‘___ Organbchlorine Pesticides’(608/8081)' '-j'.PCB’s (Arochlors)^608/8081) . ' J

I __ Microscopic ' __ Pesticides/PCB screen '(S'OS). ' ■ . _L^Herbicides (SMI 8/6630,815'1); 7 . - ,1 /^Macroscopic __ PCB as Decachlorobiphenyl (508A) , Other Pesticides. (SMI8/663oE '/ * - API,, r __ Herbicides (515) Petroleurn Hydrocarbon Scan ‘(310-13)\,$i i_-Other: 1

I-' Refrigerated?yes___ no __ Pesticides (525) s' __ Carbamate Pesticides (531) J Glycols in Water ’ % 1. ? EU Acid'Extfactables "(625/8270) ' E . < I r, Chlorinated:? yes___ no __ Glyphosate (547) _ Diquat‘(549) Base Neutral Extractables (625/8270)' _Y GC/MS'Unknown Scari s j rM' Free Chlorine Res: mg/L __ Chlorination Disinfection Byproducts (551) ■' r _ Phthalates (606MS) Total Chlorine Res;mg/L __ Haloacetic Acids (552) , L__ ■ Other: C ■ ’ .■ ■ pH ___ ___2_ '■

a RADIOCHEMICAL ANALYSIS __ Other Pesticides (SM18/6630) _ UCMR List 1 _ MtBE Only (524) •«- t I "■ ■ >■'

b •• . - k.- ~E » r . i J_Radon ' , .i- Other 2____________ ■■ ’

I INORGANIC ANALYSIS REQUESTED - Lab#: _ Color. Turbidity . __ /'cidity __ Alkalinity _ Aluminum ^'Antimony t -

\- Potassium 2Z: Selenium ij

J. i .—fpH , A -■ > __ Bromide ^Arsenic ■ ;• jZsirver- ''__ Conductivity __ Bromate/Chlorate/Chlorite ^Barium Sodium iY'« ,__ Corrosivity (temp°C) __ Chloride - . Beryllium ’. j/Thallium / — 'BOD (5 day) ‘; Cyanide I • , __ Boron, •__ Vanadium; ’__ Carbonaceous BOD (5 day)

E __ Fluoride __ Cadmium-' jZ Zinc _i_ Soluble BOD (5 day) _ Hardness; .Total as CaCOs __ Calcium, as CaCOa ,__ Chemical Oxygen Demand !'■ CLE . - __ Nitrogen, Ammonia as N __ ^'Calciurn, Ca*^ X_L Dissolved Oxygen ;■ _Metals/CN' __ Nitrogen, Nitrate as N 'l^^Chrdmium, Total *__ ■ Total Organic Carbon __ Volatiles __ Nitrogen, Nitrite as N Chromium, Hexavalent ‘ Total Organic Halides '__ Nitrogen, Total Kjeldahl as N 2 Cobalt __.'Semi-yiolatiles _1 Pesticides/PCB’s ■__ Solids, Percent, (%) *__ Oil and Grease , a/Copper' fc' •__ "Solids, Settleable __ . Solids, Suspended .__ Phenol __ Phosphorus Total as P ■i/ Iron 2/ Lead I£LP " ; ■i [4 ■_TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P. __ Magnesium >5 Solids, Total Dissolved _ Sulfates V Manganese r __ TCLP.-Pesticides __ ; TCLP-Herbicides Solids, Total Volatile __ Surfactants v* Mercury _ fCLP-Volatiies ' t i.

h Other: &.V\._____________ _ UV254 : • •i/Molybdenum ; Y/Nickel. , i/ • ^TCLP-BNA’s'

1.. J NYC-WTC_000073876