Chain of custody record, Sample AE04024, Feb 2002

NYC 9/11 Public Portal Document

■ ‘sk'r 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. 10108 ill Time/Date Set: Form A-70 (rpv 10/01)

Sample Type (circle one): P llSZ p IlH ^*)’otabie 3. Non Potable Treated Bottle #’s: <1 IS X ( T? / ->,.2 Z / .B M * f 2. Non Potable 4. Other: Chain of Custody?___ Yes No Time/Date Collected: : CM _______ "Z- ifc I 2a ConiiiiiMits: Collected By:. L. kCThjivCZ__ Agency Code:: PWS# .... Source ID: Type Descriptor: Collecb’rt From: Bill to ’/all Location’s/lndividual’s Name _ NMC CMP___ a Name/Company; . iibbiiii__ VJ__ .pr tCC_______________________ : Street_________ : City/St/Zip I : i I'/__ , N \j__ P - 2 C City/SVZip: ......

identification of Source _ _______________________________ _ Phone#: Fax#: Colieflifti: Poini (. \ ________________ . CA,CH, Bl? Check#:: Amounts ______

BACTERIOLOGICAL ANALYSIS Lab#:____ ______________________ Lab#::

ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABI.E/SOLID ANALYSIS I■ __ Heterotrophic Plate Count __ Trjljalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) _vVblatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) _i/(/oiatile Aromatics (524) __ Coliform MPN (priv well, raw, sip) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (ail samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) __ Pesticides/PCB screen (508) _ PCB's (Arochlors) (608/8081) __ Herbicides (SM18/6630,8151) 1 __ Macroscopic __ PCB as Decachlorobiphenyl (508A) __ Herbicides (515) Other Pesticides (SM18/6630) __ Petroleum Hydrocarbon Scan (310-13) I __other:__________________ _ ■ __ Pesticides (525) __ Glycols in Water F^efrigerated? yes no __ Carbamate Pesticides (531) Acid Extractables (625/8270) Chlorinated:?yes , no __ Glyphosate (547) ___ ^se Neutral Extractables (625/8270) __ Diquat (549) Unknown Scan Free Chlorine Res:_.. . - mgZL __ Chlorination Disinfection Byproducts (551) Phthalates (606MS): Total Chlorine Res: mg/Li __ Haloacetic Acids (552) __ Other:_____________

pH _____________ __ Other Pesticides (SMI8/6630) -s-SYS „ UCMRListI RADlOCHBNiiCAL ANAi.YSiS __MtBE Only (524) ___ Radon ■

_ Other: ---- JW ■

INORGANIC ANALYSIS REQUESTED - loL; __ Color __ Acidity _i(ZMuminum __ Pptassium I __ Turbidity pH __ Alkalinity __ Bromide -iiZ^ntimony .i.<:Arsenic .-T^lenium _irrlSi!ver / / / I __ Conductivity Corrosivity (temp:: __ BOD (5 day) “O __ Bromate/Chlorate/Chlorite __ Chloride __ Cyanide .^..^riuiTi _:?:fBeryllium Hui.-n __ Sodium Ml ^i-Thalliurn Vaiitidiiim I Carbonaceous BOD (5 day) __ Fluoride --Cadmium _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCO i CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium. Ca*2 __ Meia!s/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N 4^45hromium, Total ... Voialii.is __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N jssC^balt __ Pesticides/PCB’s __ Solids, Percent (%) __ Oil and Grease 2-rOpPP®'’ Solids. Settleable Solids, Suspended __ Phenol __ Phosphorus Total as P -^eaol TCLP ■ _TCLP-Metais __ Solids, Total „ Solids. Total Dissolved ___ Phosphorus, Ortho as P __ Sulfates __ Magnesium ^_zManganese _ TCLP-Pesticides TCLP-Herbicides ■ __ ;3olids, Total Volatile __ Surfactants -U-'i^efcury , . rixl- Volatiles I j/Other: S n___________ : _ UV254 -.e-Molybdenum 10„.t.N«s ..nickel i ■ NYC-WTC_000074131