Chain of Custody Record, Sample AE03833, Feb 2002

NYC 9/11 Public Portal Document ■ n <■ -

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ' WESTCHESTER COUNTY LABORATORIES AND RESEARCH ' t 1'' t 2 Dana Road, Valhalla, New York 10595 . (914) 231-1620 Fax (914) 231-1772 . . 1 ’ j

tf- Time/Date Set: . i , NYS-ELAP No.'10108 ] Forrn A-7O (rev.T0/01)’7

S^fnpIgJType (circle one): .7- 3, 4;Potab^ 3. Non Potable Treated Bottle #’s: J-

2. Non Potable 4. Other___________ L Chain of Custody?. Yes _1 No J'i - Time/Date Collected: ' 'H: Comments: - ■ 3? ■ • Confected Bv:*’^“ "Agency Code: PWS #: _____ Source"ID; " "■ Type Descriptor:- * " ‘ ' V'" ■ . Y ■ ■. Y ' ’ Collected From: Bill to: • -

I Location’s/lndividual’s Name_____________ :_____ _ ________ , Y Street________ :___________________ J____________ Name/Company "Street _____ •• ■ ' '"'.'r . V J. V '

City/St/Zip i V "" /■ Y ’ City/St/Zip _ ________ - Identification of Source ■ Phone#: 1^? Collection Point . f CA.CH, Bl? Check#: i Amounts . - ’ * .<

E I BACTERIOLOGICAL ANALYSIS Lab#: j ■ < V z- ‘V" ■■ i, V ■ Lab#:. __ _________________ __ ORGANIC POTABLE ANALYSIS . ’ ' ' ORGANIC NONPOTABLE/SOLID ANALYSIS 4

Ifc H'Heterotrophic'Plate Count ' (hemodialysis & all others) 1_,Coliform P/A (Public supplies) ’ _L’'Coliform MPN (priv well, raw, stp) __ Trihalomethanes (524) __ Volatile Halocarbons (524) Volatile Aromatics (524) __ Purgeable" Halo^rbon^,(624/8260) Z -E __ "Purgeable'Aromatics-.(624^260),,“ _/"Acrolein S^Aciylonifrile ' (8260)" ’ -■

22»Ffecar Coliform (all samples) __ Total Trihalomethahe Potential (510) __ Organochlorine Pesticicles'"(608/8081) , " V Microextractables (504) " __ PCB's (Arochlors) '(608/8081)' - ', ’ -'t -i_'Microscopic S' ■i_ Macroscopic -■ API . ' A_ Other; ■ - •>-’ __ Pes'ticides/PCB screen (508) _ PCB as Decachlorobiphenyl (508A) ' - __ Herbicides (515) ’’ _< Herbicides (SMI8/6630,8151) .V • 7^ _ Other Pesticides; (SMI8/6^0) ,x’ ' y ...a Petroleurn Hydrocarbon Scan (3W-13)>-^/s

r. ■3;

Refrigerated? yes no. ■„ ■ ► __ Pesticides (525) , __ Carbamate Pesticides < (531) __ Glyphosate (547) Glycols in Water. Yj ) J-v / _ ^cid ExtraSables (625/8270) ■; Y" 7 pV Base'Neutral Extractablfes. (62^8270) ' fc Chlorinated:? -Iv. i" ■ 7 : Free Chlorine Res:mg/L yes no __ Diquat (549) .. __ Chlorination Disinfection Byproducts (551) __ GC/MS Unknown Scan;’. ,' ,r_ Phthal^es (606MS) Y. ” • 4

I. Total Chlorine Res: mg/L Haloacetic Acids - (552) . Other:'; • ! -It-

fe pH }

Z:iRApiOCHEMICAL’ANALVSIS, ' __ Other Pesticides (SM18/6630) _UCMRList 1 ■=- _MtBE'Only (524) ‘ --J ’ Y ■ « i-;.

f ZlRadon, __: Other J" ; Y .. .

fe. ; INORGANIC ANALYSIS REQUESTED - Lab#:________ ' ' ‘-'f ■i'l ■ K. SVJ Color; ‘ Acidity ‘ - - 'j/ Aluminum p- Turbidity Alkalinity, Antimony __Potassium, ■» .V < Selenium ' ’ YizV'., '

1/ '_ ZpH >,'■ 4- • '_ .Bromide ,, */Arsenic r ^Silver> ■_ Conductivity “ Bromate/Chlorate/Chlorite ' x/Barium. ___ Sodium .-r ■ ■' :/'■

4 -__ Corrosivity (temp;___ Lr:°C) ^'Chloride' VBervIliurri - ‘‘ jZ Thallium , Zr 'BOD/5day) " . ' Cyanide -__ Bo'ron " * V'l’, _i_Vanadium'' 3- ■ ■ -YE'v ‘__ Carbonaceous BOD (5 day) •>_ Soluble BOD (5 day) ■ _j_‘ Fluoride ^- Hardness, Total as CaCOa __ Cadmium Calcium," as’CaCOa .X-Zi?)c/C si-n * -1 . r 1 ___ Chemical Oxygen Demand __ Nitrogen, Ammonia as N Calcium,' Ca« S^ells/CNt ■ ' " F __ Dissolved Oxygen :__ Total Organic Carbon ‘ Nitrogen, Nitrate as N __ Nitrogen, Nitrite as N ^Chromium, Total Volatiles ‘

r “ Chromium, Hexavalent _ __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N _2 SemKviolatiles^ “■ V Cobalt" V ■ ZZcopper - Jz __ Pesticides/PCB's );/.:• __ ■* Solids, Percent (%)' __ Oil and Grease _• Solids, Settleable Phenol ' . . ■jZlron __ Solids, Suspended _ Phosphorus Total as P ■' ■ \/Lead , ' ■ i£kP - Y- L_ Solids, Total ‘ ' -JlTCLP-Metals 4 _ Phosphorus, Ortho as P Magnesiurh' II.. __ Solids, Total Dissolved __ Solids, Total Volatile vf Other: '• .__ Sulfates _ ;■ Surfactants _ UV254 S' '/^Manganese ^Mercury ZZMolytxJenum _ TCLP-Pesticides _TCLP-Herbicides _;TCLP-Voiatiles‘' " '

_TCLP-BNA’s u B.. = ' —-V-------------- - 2^ Nickel . J,.

.Visii. '-L',.. .-V 7u:a:';

NYC-WTC_000073906