Chain of Custody Record, Sample AE03944, Feb 2002

NYC 9/11 Public Portal Document ENVIRONMENTAL SERVICES SAMPLE SUBMISSION EORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH it 2 Dana' Road, Valhalla, New York 10595 (914)'231-1620 Fax (914) 231-1772 NYS-ELAPNo. 10108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type (circle one): AP. rd (J)Potable 3. Non Potable Treated Bottle #'s:

2. Non Potable 4. Other _ ____________ Chain of Custody? Yes___ No I Time/Date Collected: n 9,^^ Ml H10^ Comments: Collected By; Agency Code: PWS #;_________ Source ID: Type Descriptor: Collected From: Bill to: 1 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#: 1

Lab#:___________________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count ji^^Trihalomethanes (524) (hemodialysis & all others) , __ Purgeable Halocarbons (624/8260) , . Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) . __ Coliform P/A (Public supplies) ^^olatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Coliform MPN (priv well, raw, stp) __ Fecal,Coliform (all samples) . Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) m i __ Microscopic __ Microextractables (504) _ PCB's (Arochlors) (608/8081) _ Pesticides/PCB screen (508) __ Herbicides (SMI8/6630,8151) '7.- __ Macroscopic _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI 8/6630) __ Other:________________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13)i-' __ Pesticides (525) __ Glycols in Water ' Refrigerated?yes___ no __ ^Carbamate Pesticides (531) __ Acid Extractables (625/8270) j,’ Chlorinated:? yes___ no __ Glyphosate (547) __ Base Neutral Extractables (625/8270)7- __ Diquat (549) __ GC/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other;________ __ Other Pesticides (SM18/6630) pH _____________ _UCMR List 1 I RADIOCHEMICAL ANALYSIS _MtBE Only (524) ___ Radon i __ Other_______________________

INORGANIC ANALYSIS REQUESTED - Lab#: ___ fu __ Color __ Acidity __ Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony __ Selenium _ pH __ Bromide __ Arsenic __ Silver ! __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium ' Sodiurri __ 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 CaCOa ___ Calcium, as CaCOa __ Calcium,'Ca+2 £LP i __ Chemical Oxygen Demand __ Nitrogen, Arnmonia as N _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent ZZ^otal Organic Halides __ Semi-violatiles __ 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

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