Chain of custody record, Sample AE04024, Feb 2002

NYC 9/11 Public Portal Document

iWHMHMIMMM . ■■ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ACCo.: 1 1 , WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 8W fl?

IL? BJLrLM? •' i I. -

■ NYS-ELAP No. 10108: Time/Date Set: |U|o-7j Form A-70 (rev. 10/01):

Sample Type (cirde one): P 198 F I' I■ ^“otoble 3. Non Potable Treated' f Bottle<_2itoL^±±<> 7

2. Non Potable 4, Other: Chain of Custody?___ Yes No Time/Date Collected:: i (to ' <-/ < Comments: Collected By: L. U-rP' jTTk / Agency Code:: Source ID:: Type Descriptor:: B Collected Fronr Biii to. Location’s/lndividuai's Name___ H’yC Pr P_____ Name/Company ■i Street___ ___________________________________________ . Street________ i City/SVZip \/-to Uv.- f L - " I 1 'i "t S City/St/Zip___ : Identification of Source: Phone#; Fax#:^ Collection Point pc I CA.CH. Bl? Check#:: Amounts:

BACTERIOLOGICAL ANALYSIS Law:------------- ■-to-to-H----- Lab#;__________________________ : ORGANIC POTABLE ANAiASiS ORGANIC NONPOlABLE/SOLiD ANALYSIS __ Heterotrophic Plate Count IB: __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) .G^latile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp): , >Volatile Aromatics (524) __ Total Trihalomethane Potential (510) __ Acrolein & Acrylonitrile (8260) __ Organochlorine Pesticides (608/8081) HI __ Fecal Coliform (ail samples) __ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) IB __ Macroscopic __ Pesticides/PCB screen (508) __ PCS as Decachlorobiphenyl (508A) __ Herbicides (SMI8/6630,8151) Other Pesticides (SM18/6630) ■■Hi B _ API Bi __ Other;_______________________ _ __ Herbicides (515) __ Pesticides (525) __ Petroleum Hydrocarbon Scan (310-13) Glycols in Water id s Refrigerated?yes no __ Carbamate Pesticides (531) __ Glyphosate (547) _ Acid Extractables (625/8270) __ Base Neutral Extractables (625/8270) 1} Chlorinated:?yes _... no __ Diquat (549) _>-<GC/MS Unknown Scan Free Chlorine Res;mg/'L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L pH ------------------- ----------------------- : __ Haloacetic Acids (552) _ Other Pesticides (SM18/6630) Other:_______ ________________________ _ I UCMR List 1 _MtBE Only (524) ___Radon __ Other .

INORGANIC ANAi.YSiS REQUESrED -1 .to# a■ __ Color Turbidity pH Acidity __ Alkalinity __ Bromide Aluminum G^ntimony _j=Grsenic __ gotassiii □■Selenium ■■Silver ■■ i

__ Conductivity __ Bromate/Chlorate/Chlorite GJarium no Corrosivity (temp;’ BOD (5 day) °C) __ Chloride __ Cyanide □■Beryllium __ Boron __ Sodium □■'‘Thallium __ Vanadium- i3 __ Carbonaceous BOD (5 day): Fluoride _tJ3Sdmium □S^inc __ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOa __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca+2 CLP I® 80 __ Dissolved Oxygen Total Organic Carbon __ Nitrogen, Nitrate as N __ Nitrogen, Nitrite as N _i<firomium. Total Chromium, Hexavalent: __ Metals/CN Volatiles __ Semi-violatiles o loi Total Organic Halides ._ Nitrogen, Total Kjeldahl as N bait __ Pesticides/PCB’s Solids, Percent (%) __ Oil and Grease pper Solids, Settleable __ Phenol .Bllllllllllllilill TCLP Solids, Suspended __ Phosphorus Total as P JtfCead . _TCLP-Metals ___ Solids, Total __ Phosphorus, Ortho as P __ Magnesium i./l^anganese __TCLP-Pesticides __ Solids, Total Dissolved Sulfates _ TCLP-Herbicides __ .fioHds Total Volatile __ Surfactants srcury TCLP-Voiatile:; jZ other: ________ : _ UV254 .■■Molybdenum .G^ickel . ICLP-BNAs ■li

NYC-WTC_000074132