Chain of Custody Record, Sample AE03833, Feb 2002

NYC 9/11 Public Portal Document . r-r .. . ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH . • ' 2 Dana Road, Valhalla, New York 10595 . ’ (914)231-1620 Fax (914) 231-1772 .^LiJSaHBs' NYS-ELAP, No. 10108 Y, “• , Time/Date Set: Form A-70 (rev.'l 0/01) / J y Sample Type (circle one): . 1. Potable 3. Non Potable Treated Bottle #’s:J ;2. Non Potable 4. Other Chain of Custody?, Yes No ' Time/Date Collected: •’ //'■ h I U /- Comments:; ■ Collected By:,_____ I Vi Agency Code: t.V PWS #: -_______ ^ Source ID: Type Descriptor:" - .

I, . Collected From: , 'K -' Location’s/lndividual’s Name ‘ . ' . ‘ '-'KlU' Y!zt,yjY. Bill to: ' Name/Companv ■ I'

'street ■ _________ __ Street _____ ; City/St/Zip_________ ______ City/SVZip ■a..

■ Identification of Source Phone#: _____ Fax#:. 'it *n " K t

.Collection Point I CA,CH, Bl? Check#: ■ -. Amounts'' ..■ 4- ■; 4

- Lab#: f 1/'L ; ■/ ‘-LB 7^^ J BACTERIOLOGICAL ANALYSIS ’

ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/ SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihaiomethanes (524) ‘ - j _ Purg'eable Halo'csirbons- (624/8260). I ■ ■ ' (hemodialysis & all others)

3- Coliform P/A (Public supplies) 2^1' Coliform MPN (priv well, raw, stp) ._l![^ecal Coliform (all samples) _ Volatile Halocarbons' (524) __ Volatile Aromatics (524) __ Total Trihalomethane Potential’ (510) , , 2_ Purgeabiej^romatics (624/8260)’ ^ ' Y j_'’ Acrolein & Actylpnitrile (826b)t,. _ Organochlorine Pesticides (608/8081) - f .. j _ Microextractables (504) • YX.PCB’s.(Arochi(5rs)/608/8081)Y/ V • ? 1/ R _ ^Microscopic' :_ ‘Macroscopic t . '__ Pesticides/PCB screen (508) ^JHerbicides:(SMT8/6630,8151.) z ’ . A*. {

s fV __ PCB as Decachlorobiphenyl (508A) LJLOther Pesticides/SM 18/6630); /'J ,, i' .s .L_:=API ' _ Herbicides (515)' ‘__ Petroleum Hydrocarbon Scari (31’0-13) /^* ? . Other:;. __ Pesticides .(525) 4 ‘ , , ,._l'-:Glyc6ls'inWater.' 'A 1/ yK Y. Refrigerated? yes__ no __ Carbamate Pesticides (531) • -Atid Extractabies, (625/8270) - , i. Chlorinated/?' _ yes _ no __ Glyphosate (547) /-/Base Neutral-Extractables '(625/8270) b- ‘_;Diquat (549) J / GC/MS Unknown Scan .T- YYYS j- Free Chlorine Res: mg/L . __ Chlorination Disinfection Byproducts (551) V-r:Phthalates (SOeMSp / . / I.' ‘■1 J Total Chlorine Res: -- " ■ _1_ mg/L '__ Haloacetic Acids (552) _Other Pesticides (SMI8/6630) Other: ’ < 2.Y YP 2-, i r ;RADIOCHEMICAL ANALYSIS LRadon ", / - . Oy^r - / _UCMR List T. _MtBEOnly (524) • .> \ "i??

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INORGANIC ANALYSIS REQUESTED - Lab#: * ^•Color’i,; ■ . , r __ :Acidity/, __ Aluminum ’ __ ’ Potassium - t " I _3 Turbidity ^ ' _ Alkalinity Antimony' ,, . Seleriium * pH __ Bromide _ Arsenic ‘ ■_'Silver''.\j„ r. __ Conductivity " . Bromate/Chlorate/Chlorite' _ Barium '__ Sodium

f: '_ Corrosivity - (temp:°C) _ BOD. (5 day) __ Chloride’ __ Cyanide .__ "Beryllium -■__ Boron-" ‘ ■■_: Thallium , Y'.'- .’ ' ,__,Vanadiurn . ' ’ • B ■__ Carbonaceous BOD .(5 day) ’_ Soluble BOD (5 day) , __ Fluoride __ Hardness, Total as CaCOa __ Cadmium • __ Calcium, as CaCOa " :_ Zinc '' ;

I i-. __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N _ ___ Calcium, Ca*^ , " j, "clF Y, , - if -1 .Y^Metals/CN^,,=Y’ __ Dissolved Oxygen if- 2 __ Total Organic Carbon _ f Nitroge’n, Nitrate as N Nitrogen, Nitrite as N __ Chromium, Total ? Chromium, Hexavalent .2^ Volatiles ’ - 1 _?^^Semi;violatiles __ Total Organic Halides __ Nitrogen,'Total Kjeldahl as N ;___ Cobalt -- Pesti cides/PCB’s -s __ Solids, Percent. (%); , . Solids, Settleable __ Oil and Grease _ ; Phenol __ Copper __ Iron i t-'t' >. Ui L* I __ Solids, Suspended __ Phosphorus Total as P ICLPy Y _ ; Lead ' ■LJTCLF’-Metals ‘ : K __ Solids, Total ’ ___ Solids, Total Dissolved Phosphorus." Ortho as P __ Sulfates ‘ ■l_; Magnesium _ Manganese .2. TCLP-Pesticides __ TCLP-Herbicides _ Solids, Total Volatile __ Surfactants __ Mercury _-.TCLP-Volatiles" __ Other: -_____________ _ UV254 :_ Molybdenum '1 ___ ____________________________ __ Nickel _ TCLP-BNA's/ i

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