Chain of Custody Record, Sample AE03914, Feb 2002

NYC 9/11 Public Portal Document

r ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM .Mfestehester WESTCHESTER COUNTY LABORATORIES AND RESEARCH

I' '- 2 Dana Road, Valhalla, New York 10595 ’(914) 231-1620 Fax (914) 231-1772 / 1*5 i ' NYS-ELAP No. 10108 | Time/Date Set: Form A-76 (rev. 10/01) i

Sample Type (circle one): * Bottle ri____________ (j(' <,i iv/// 7 ’/ 'j / I ’ i ■

V-V 1: Potable 3. Non Potable Treafed 2.'Non Potable 4. Other -■ _____ (Shain of Custody? -Yes ■ ■ No , ’ ’ 1, I Time/bate Collected: < ____ _______ Comments:_______ _ K Collected By; j. H fb '•' Agency Code: PWS Source ID:' Type Descriptor: .. R Collected .From: ■ >i .. ■ ( ) ' Ue “"■**’=> RR:,: - ' , 4'. -, Location’s/lndividual’s Name .r V 1 Name/Comoanv ■* JS, Street __________________ __ Street’ - " YCity/St/Zip___________________ Citv/St/Zio '■ Identification of Source Phone#; . -' ; . ,Fax#:

Ift- Collection Point 7______________ i. .1 < BACTERIOLOGICAL ANALYSIS .. ■ Lab#: CA,CH, Bl? Gheck#: Amounts 1

i-ab#: “ ' ‘‘ ~ - ~ CT 7 / ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS ;

s R Heterotrophic Plate Count . S;(hemodialysis & all others) , J_i c6liform P/A (Public supplies) ■_i.tColif6rm MPN (priv well, raw, stp) Fecal Coliform '(all samples) -_*i. Microscopic" .J_ Trihalofnethanes (524) __ Volatile Halocarbons (524) __ Volatile Aromatics (524) __ Total Trihalomethane Potential (510) ;_ Microextractables'(504) ? _ Pesticides/PCB screen (508) * il’ Pungeabl^Haloc^bdns (624/826(3)'.- __ Purge'able Aromatics (624/8260) ^■^Acroleih & Acrylonitrile, (8260) Orgariochiorine Pesticides “(60878081) ,A PCB’^(Arochlors)?(608/8081)-. y .£7? _/Herbicides“'(SMl8/6630;8151) ;; 1

M r’ '

11* Macroscopic RAPl- \ PCB as Decachlorobiphenyl (508A) _/Other Pesticides (SM18/6630)" r . >1? _2\0ther: _ Herbicides (515) Petroleum Hydrocarbon Scan (310-13) ■ _ Pesticides, (525) il.Glycols in Water ' ‘''7 777’’'^;^'

I Refrigerated?yes Ch'lorinated:? ’J ■ T ■ yes ■ =■ -' no no _ Carbamate Pesticides- (531) __ Glyphosate', (547) __ Diquat (549) 7^-AcicJ;Extra^abies-(625/8276);. . ’ . YjT-Y Base Neutral'Extractables^ (625/8270) ' p*i 2'!' GC/MS Unknown Scan >-• .

I A---. J — Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) liPhthalates (606MS)>t“ -fl' Total Chlorine Res: _____ mg/L _ Haloacetic Acids (552) j f " Other:2L±2_hjil_______ _______ 1? r . _ Other Pesticides (SMI8/6630)' _UCMRList1 .

I -’'RADIOCHEMICAL ANALYSIS 2__ Radon" 12 Other _ ’•_>MtBE Only (524).

V ’V, 1

5/' INORGANIC ANALYSIS REQUESTED - Labft 7 - ._i’ Color ■ ; - ‘ ‘ ■ /Acidity . ' ___;____ __ Aluminum ’^1' , / ; iPotassium. ► 1-' y-

'H , *< "- ‘f

F’S-.- ? Turbidity. H pH '- ,5__ ■Conductivity 7 ^ ■■ ‘ .1? '^1,7.. ; 1 ‘ _ 7-Alkalinity '

H'Corrosivity (ternpjj__ _°C) - ' —Chloride 2 ■' __ Bromide ’' ' Antimony I .i -’’' "-w _Arsenic ; ,.^ Bromate/Chlorate7Chlorite i 7^-' i-" Barium f?' ■> 21 -■__ ‘Berylliurn ', _£SeleniurTi'7 I Silver f ; flL Sodium: . '7i.'Thalliurn 7 J „ 7.f'‘1 : J '2cl BOD2(5'day) ... ,, ’ -7; '__ Cyanide a * '''1. .r Boron ' ■ ” 7; fe*' Vanadium \ l,;'—

6; _fc7Carbonaceous BOD (5 day)"' "__ Fluoride H Soluble BOD., (5 day) -S '2 21/Chemical Oxygen Demand ’ - ; _£ Hardness, Total as CaCOa , _Ca'dmium 1‘i Calciurn, as CaCOa' __ Nitrogen,'Ammonia as N . ’ m __ Calciurn, Ca^'^ -l - CLP / i -r, Dissolved Oxygen , __ Nitrogen, Nitrate as N '12 ___ Chromium, Total 17-',. rji;Metals/CN ’ _ 1 Total Organic Carbon 12 Total Organic Halides. . _ ; Nitrogen, Nitrite as N __Chromium, Hexavalent > __ Nitrogen,'Total Kjeldahl a^N ,__ Cobalt . < « ' \ 1 '^-.■Volatiles 712 Semi-violatiles f 7 1 , _ Oil 'and Grease _ -Copper *’■»• '. ’• ' ___' Pesticides/PCB’s . h'- __2. Solids, Percent (%) “r ,7'-p’ _J Solids, Settleable ' __ Phenol J‘jI Iron, t* " j:, 7iclp 7" 7,-,? _j. Solids, Suspended " ‘ '__ Phosphorus Total as P % . 2_ Lead .XTCLP-Metalf.jg " F Solids, Total 5, __ Phosphorus; Ortho' as P- _ Magnesium ' /•' ■_i tCLP-Pesti'cides 1 .Solids, Total Dissolved ' _ _ Sulfates __ Manganese .7 ■’■y ' i_TCLP-Herbicides _i Solids, Total Volatile' ’ •__ Surfactants- ' __ Mercury - •t ■ TCLP-Volatiles _T. Other;_______ _ _ UV254' _1 Molybdenum’ 1; * . __ ■ Nickel ■ ’ '7 < . ■ "6” jI TCLP-BNA’s"-- - J NYC-WTC_000073917