Chain of Custody Record, Sample AE03833, Feb 2002

NYC 9/11 Public Portal Document

F'V :■ '/y "■ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 u/ ■ I I eMC: NYS-ELAP. No.'10108 •’

f -I- t'' jTime/Date Set: Form A-70 (rev. 10/01) . ' ‘ i -j • <•

^mpJe^Type (circle one): VOS I V ■ "X- (j^PotableJ)' 3. Non Potable Treated Bottle #'s:'AA % <A f 2. Non Potable 4. Other Chain of Custody? Yes 2^>No . , T /■ "Y- i'Time'/Date Collected: Comments; 5?"' PWS #: '_____ Source ID: 2. ) Collected By: Agency Code: _Type Descriptor:-. h‘ . 5- ■ -t; I Collected From:^ > Bill to: K' ' Location’s/lndividual’s Name______________ 2_______ i.'‘Stre^ -- / • •' •/ Name/Company h

Street

ta- s City/St/Zip '________________________________ j' Identification of Source_____ :_____________ City/St/Zip___ 1 Phone#: ' Fax#: -± -I

f . Collection Point CA.CH.’BI? Check#: 1 Amounts 7 'y,^ ft BACTERIOLOGICAL ANALYSIS Lab#: 'k Lab#: t» ■’' ORGANIC POTABLE ANALYSIS ORGANIC NONPOTAb'lE/SOLliy analysis Heterotrophic Plate Count ' P.ufgeable Halocarbons ‘(624/8266) .... , t __ Trihalomethanes (524) . , S ' (hemodialysis & all others) __ Volatile Halocarbons (524) 'Purgeable Aromatics (624/8260) / -Y" " Coliform P/A (Public supplies) __ Volatile Aromatics (524) .‘_J Acrolein & Acrylonitrile (8260)' ’ ' Wi'-? _T Coliform MPN (priv well, raw, stp)

bb 2_sFecal Coliform (all samples), ' _t/Microscopic “Macroscopic' __ Total Trihaiomethane Potential (510) __ Microextractables (504) __ Pesticides/PCB screen (508) ' . ..2_'.Organochlorine Pesticides' (608/8081 ),• PCB's (Arochlors) (608/8081)' L _Y'-Herbicides (SM18/6636,8151) Y j

fc" - API , , '' Other:’' __ PCB as Decachlorobiphenyl (508A) __ Herbicides '(515) . ■ __ Pesticides (525) _"Other:P^ticid^‘ (SMI8/6630) Y- Petroleum Hydro'carboh Scan (310-i"3) Y’ j Glycofs'in.Waterf J-.’ ‘

KJ Refriger^ed? yes__ _ no _ Carbamate Pesticides (531) __ L Acid ExtractableS. (625/8270) ’ ’T. , 4/

I Chlorinated:? yes __ Glyphosate (547) Base Neutral Extractables' (625/8270) . no ■ J- ‘ _Diquat (549) ’’ , , * 2_ GC/MS,Uhkn6wn Scan'../', ■?' Free Chlorine Res:^i mg/L _ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) s- "/' / ‘ .

I .Total Chlorine Res:____ phV^. J.,- _ mg/L __ Haloacetic Acids (552) _Other Pesticides (SMI8/6630) ' ’ Other; t

ft _UCMRList1 , 5 S. MtBE Only (524) ' A

fe ( RADIOCHEMICAL ANALYSIS i_LiRadon ’ Other,-' "Y. i - 'yj

ft INORGANIC ANALYSIS REQUESTED - Lab#: ’ A'Color'. - " '■ ' ■ - __ ■ /Yiidity • Alu'mihurh ' ’ ”---A

__ .Potassium I ? ft ' '

»4v .lY Turbidity ' __ Alkalinity j/Antimony . ' v^Seleniums,,|’-..y.. J! I pH 'ft. - < ■ Y. " ' ‘ '__ Bromide > ,..v<Arsenic ' ^Silver,* ,. , T Ai- T -i

’A Yi Conductivity * ,' _1_ Brornate/Chlorate/Chlorite '^ Barium . :i_,Sodium,^ 4' ^^Corrosivity (temo: °Ci __ Chloride Beryllium .Y Thallium .7

s ,^'n .BOD (5' day) ' _ Cyanide __ Boron. _Y'Vanadium ' __ ‘ Carbonaceous BOD (5 day) __ -Fluoride " ■ Cadmium —Zinc ft ? Soluble .BOD J5 day) .- ' ’ ___ Hardness. Total as CaCOs __ Calcium, as CaCOa __ -Chernical Oxygen Demand • , ’ __ Calcium, Ca*2 . ■ ’ Y?rf^ Ai CLE Y Y. . ..‘• Y - __ Nitrogen, Ammonia as N "4 LLMetals/CN;'. . ?■ ,__ Dissolved Oxygen Total Organic Carbon __ Nitrogen, Nitrate as N __ Nitrogen, Nitrite as' N - YLChromium, Total' .. . Y - Chromium, Hexavalent I-T Volatiles' ■' '' '' Nitrogen, Total Kjeldahl as N ^Cobalt ,Y ftX Semi-violatiles . ‘ . i ■ ■ Total Organic Halides _^ Pes«cideS/PCB’s ' - ,

fcS' Solids, Percent (%) __/ Oil and Grease Copper "" ■ i - ’ .Y Solids, Settleable _Y Phenol ■ • 7 Iron ___ Solids, Suspended __ Phosphorus Total as P Lead ‘ . . -s.. ■ICLE...± ft -1 "r i:L;TCLP-Metal^ __ Solids,tTotal , __ Phosphorus, Ortho as P Magnesium b ’_.Solids, Total Dissolved J_ Sulfates' ' " .j^Manganese - - » _:TCLP-Pesticides . ‘ “• _/Solids,*Total Volatile __ Surfactants C/Mercurv __ TCLP-Herbicides ..

I- Other: _^rv____________ _ UV254 '

...L -Ya- Y. - ^Molybdenum .^Nickel,,

'fc _ TCLP-Volatiles ■' ’ . _TCLP-BNA’s. '( ■■ • > ", . 1

r _____ ... 1. NYC-WTC_OO6O739O7