Chain of Custody Record, Sample AE03934, Feb 2002

NYC 9/11 Public Portal Document 13 ACCo ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■Wfeytchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type (circle one): 1. Potable . 3. Non Potable Treated Bottle #'s: 2. Non Potable ■ 4. Other____________ Chain of Custody? Yes___ No Time/Date Collected:: /I ft/h Comments: • Collected By: Agency Code: PWS #::________ Source ID: Type Descriptor: Collected From: Bill to; Location’s/lndividual’s Name Name/Company Street_________________ Street_________ City/St/Zip______________ City/St/Zip Identification of Source Phone#:_______ Fax#: Collection Point CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count _<rjrihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) ^olatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _j^<Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) __ PCB’s (Arochlors) (608/8081) __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,'8151) C: ; ’ __ Macroscopic _ API __ PCB as Decachlorobiphenyl (508A) __ ■ Other Pesticides (SMI,8/6630),:;. __ Herbicides (515) __ F’etroleum HydrocarboA Scanf,(-310-13) __ Other:_____________________ __ Pesticides (525) __ Glycols in Water ,/ Refrigerated?yes no __ ^Carbamate Pesticides (531) __ Acid Extractables (625/8270) . __ Glyphosate (547) __ Base Neutral Extracfible^625/8270) Chlorinated:? yes___ no __ GC/MS Unknown ScahT^ __ Diquat (549) Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS)' Total Chlorine Res;mg/L __ Haloacetic Acids (552) __ Other:__________ '<2 __________ __ Other Pesticides (SM18/6630) pH ___________ _UCMRList 1 RADIOCHEMICAL ANALYSIS _MtBE Only (524) __ Radon _ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ /cidity __ Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony __ Selenium _ pH __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium __ Sodium __ Corrosivity (temp:. °C) __ Chloride __ Beryllium __ Thallium _ BOD (5 day) __ Cyanide __ Boron ■__ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium __ Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOs - Calcium, as CaCOs CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Metal s/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles __ Total Organic Carbon .__ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Cobalt __ Pesticides/PCB's __ Solids, Percent (%) __ Oil and Grease __ Copper __ Solids. Settleable __ Phenol __ Iron tclp __ Solids, Suspended __ Phosphorus Total as P __ Lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates __ Manganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants __ Mercury _ TCLP-Volatiles __ Other;_______ __________ _ UV254 __ Molybdenum _ TCLP’-BNA's __ Nickel

NYC-WTC_000073968