Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document AOCn 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-ELAPNo. 10108 Time/Date Set; Form A-70 (rev. 10/01)

Sample Type (circle one): ^^Potable 3. Non Potable Treated Bottle # s: 2. Non Potable 4. Other__________________________ Chain of Custody?___ Yes _ Mo Time/Date Collected: 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 3;2- CA,CH. Bl? Check#; Amounts

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:__________ _________ _ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SdLID ANALYSIS __ Heterotrophic Plate Count _5:fTphalomethanes (524) (hemodialysis & all others) __ Purgeabie Halocarbons (624/8260) J:<wilatile Halocarbons (524) __ Purgeable Aromatics (624/8260)" ‘ __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _^/wlatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) * __ Organochlorine Pesticidas^^j^081) __ Microextractables (504) _ PCB's (Arochlors) (608/8(W'^ __ Microscopic __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,815 __ API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SM18/66j6) __ Other:_____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water Refrigerated?yes___ no __ ^Carbamate Pesticides (531) __ Acid Extractables (625/8270) 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 _MtBE Only (524) __ Radon __ Other____________________ I

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity __ Aluminum __ Potassium , __ Turbidity __ Alkalinity Antimony __ Selenium _ pH __ Bromide __ Arsenic __ Silver Conductivity _ , Bromate/Chlorate/Chlorite 4 __ Barium __ Sodiurii __ 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 CaCOc 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-violatiies __ 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-ENA's __ Nickel

NYC-WTC_000074096