Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document _ AC'Cn ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 101*08 Time/Date Set: Form A-70 (rev.10/01)

Sample Type (circle one): f IjPotable 3. Non Potable Treated Bottle #'s:. 42m T- 2. Non Potable 4. Other j Chain of Custody?Yes__ _ No Time/Date Collected: ft' 3- 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#: X. Collection Point CA,CH, Bl? Check#: Amounts ■ c c

BACTERIOLOGICAL ANALYSIS Lab#;_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count _^:^rihalomethanes (524) (hemodialysis & all others) __ Purgeable Halocarbons (624/8260) _^^olatile Halocarbons (524) __ Purgeable Aromatics (624/8260) ' __ Coliform P/A (Public supplies) __TVolatile Aromatics (524) __ Coliform MPN (priv well, raw, stp) __ Acrolein & Acrylonitrile (8260) :; __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides i(608/8Q.81) -“i __ Microscopic __ Microextractables (504) __ PCB's (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8131) __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SMI 8/66^0) __ API __ Other._____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) _ Acid Extractables (625/8271^ Chlorinated:? yes no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) _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 (SMI8/6630) pH ___________ __ UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBEOnly (524) __ Radon _ Other_______________ _

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity __ Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony __ Selenium _ pH __ Bromide __ Arsenic __ Silver I __ 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 CaCOa CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Metals/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

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