Chain of Custody Record, Sample AE03914, Feb 2002

NYC 9/11 Public Portal Document •*Y’ ■ ' 'Y ‘u '!

fir <1 ” VwLy6StGh.cs*L0r* ’ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH ! 2 Dana Road, Valhalla, New York 10595

r ■ . . (914)231-1620 Fax (914) 231-1772 NYS-ELA’p. No. 10108 1 Time/Date Set; Form A-70 (rev.10/01) ;

Sample Type (circle one):' /"pWp ’ r ir- /" fl Potable 3. Non Potable Treated.. SV ' Bottle #’^; •A-Y . ' 2. Non Potable 4, Other____________ ■' /■ Chain of'Custody?'Yes No

If' . Time/Date Collected: .a Comments: Collected By:,_j2YVE?yjVnL_ Agency Code; 1 PWS #: - ■ Source ID; V Type Descriptor: a

I?' Collected From: f Bill to:’ docation’s/lndividual’s Name _ , Name/Company

E ■ Street_________ -___________ lcity/St/Zip'_J______________ 2 _ ' Street City/St/Zip .. “ ' J

'Y k- ' Identification of Source Phone#:< Fax#:

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

BACTERIOLOGICAL ANALYSIS Lab#;___________ ________ F’* Lab#: ' __________ ! ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLib ANALYSIS ' Kr: _7 Heterotrophic Plate Count ’J_Trihalomethanes (524)’ Purgeable Halocarbons'.(624/8260) .-_.f i? / I (hemodialysis & all others) __ Volatile Halocarbons (524) ' Purgeable AromaticsY(624/826O) ' i 7 _Li Colifofni P/A (Public supplies) t Coliform MPN (priv well, raw, stp)' ■_£ Fecal Coliform (all samples) __ Volatile Aromatics (524) , __ Total Trihalomethane Potential (510), _ Acrolein & Acrylonitrile (8260) *■,’ _2 Organochlorine Pesticides , (608/8081) *>“■ 1 Bi _ T Microscopic __ Microextractables (504) PCB’s (Arodhlors) "(608/8081)“ " ' ■_ ’Macroscopic __ Pesticides/PCB screen (508) i_’Herbicides (SMI 8/6630,8151) . ! .JI’API " ’ ‘__ PCB as Decachlorobiphenyl (508A) ___ Other Pesticides e(SM18/6630)' Y Other: - ■___________ __ __ Herbicides (515) _j_ Petroleum Hydrocarbon Scan (310-13) ’ s ’ ■ >1; __ Pesticides (525) .L_ Glycols'in Water,,. ‘Y • lY’:' Refrigerated? yes_ _ no __ Carbamate Pesticides (531) ’Y-; Acid Ektractabl^Y^25/8270) " ' , ; Chlorinated:? yes no Glyphosate (547) . '__ Base Neutral,Extractables (625/8270) / '■ft-'. __ Diquat (549) j^xGC/MS Unknowti Scan ’ • ■' .Yj It' Ft^ee Chlorine Res: mg/L ? ■■■ __ Chlorination Disinfection Byproducts (551)_ Phthalates (6Q6MS) )

II Total Chlorine,Res:mg/L pil' : 'Y.- RADIOCHEMICAL ANALYSIS \ ‘ 2_ Haloacetic Acids (552) _Other Pesticides (SMI8/6630) _ UCMR List 1 _ MtBE Only (524) 3 __ Other:!

i , * 7 1 -J ■■ fc _£.Radon.,. __ Other' E E ?'V i /- . r Z- S' .^INORGANIC ANALYSIS REQUESTED - Lab#: _J Color - t Acidity Acidity .^•Aluminum -p •>’e__ Potassium JY'Turbidity __ , PH., Ej - . ’ .■N

__ Alkalinity __ Bromide ' ' w Antimony . _Y-Seleniurn _ YjSilyer?, I ’ / 1 I- L3. Conductivity >_J Corrosivity (temp:____ °C) il^ BOD (5 day) * ' __ Bromate/Chlorate/Chlorite __ Chloride ; “ i Arsenic' ^.Barium ’ _^-Beryllium ,, " Y i ■ - YJ_'Sodiurri| „ j 4i-Thallium \... '.A"' 4 __ Cyanide;, - • - _L Boron " _ ’ .-■' ' Vanadium '’■> I __ f Carbonaceous BOD (5 day) jd, Soluble BpD (5 day) ’ -Et Chemical Oxygen Demand _ Fluoride’’ __ Hardness, Total as CaCOa __ Nitrogen, Amrhonia as N j, _ Cadmium _ Calcium. as CaCOs ■ ’ P _ Calcium’, Cat^ \ - ’_L^inc .Y Y CLE r ,, ■ ?< 'I ■ Dissolved Oxygen _ _ Nitrogen, Nitrate as N •‘_EMetals/CN t ■ j/'Chromium, Total ' ' _Y, Total Organic Carbon , * , __ Nitrogen,'Nitrite as N • JY Chromium, Hexavalent - Volatiles - ' t ■n; ■"

•_ 5 Total Organic Halides _2>Nitrogen, Total Kjeldahl as N1 ,^Cobalt . ' i_.Semi-violatiles j Solids,'Percent (%) J_- Pesticides/PCB’s; ■' Oil and Grease YYCopper ,, i_ i Solids,; Settleable ■ Phenol ’ jY Iron, ■ ‘_ 1 Solids,- Suspended _ Phosphorus Total as P' j/Lead - ; , ■' I£LE •_j Solids, Total / ’ _±- Solids,‘Total Dissolved ”■ Solids, Total Volatile JlYOther; 'Y.AT __ ’ Phosphorus, Ortho as P, __ Sulfates , __ Surfactants « __ Magnesium j;2''Manganese. -.■ Mercury ■’%

, , ’CLTCLP-Metals - ,su;'TCLP;Pesticides * _ TCLP-Herbicides Y' _ TCLP-Volatiles I _ UV254. J/ Molybdenum _TCLP-BNAs ’ ■■ Ek • ' ' ■ Nickel - Y-

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