Chain of custody record, Sample AE04024, Feb 2002

NYC 9/11 Public Portal Document ilOi

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM , c;i " ' ■li WESTCHESTER COUNTY LABORATORIES AND RESEARCH Wf Mt) Ej 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01) jOsBOgoBOO

Sample Type (circle one)? 1, Potable 3. Non Potable Treated Bottle #'s: . iP-H I< i B 2. Non Potable 4. Other 4_____ ,_________ ______________ : :__ ri h I ....______ _ Chain of Custody?___ Yes: Comment;-;; No ■ Time/Date Collected:^ rws #; ___ I Collected By:_______J__; Collected From; • __________Agency CoCe: Bill to Source ID:Type Descriptor: ■ Location’s/lndividual’s Name U Name/Company:

Street_______ _________ _—_ Street:

City/St/Zip__ _____________ City/St/Zip identification of Source Phone#:______ , Fax#::

Collection Point CA.CH, Bi? Check#:: AmountS:

bacteriological, analysis Lab#:i . ............... / i LPh#: ............................................. —-

■ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & ail others) __ Volatile Halocarbons (524) Purgeabie Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp): ___Volatile Aromatics (524) Acrolein & Acrylonitrile (8260) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Fecal Coliform (all samples)

I __ Microscopic Macroscopic __ Microextractables (504) __ Pesticides/PCB screen (508) PCB's (Arochlors) (608/8081) „ Herbicides (SM18/6630,8151) iali IB I __ PCB as Decachlorobiphenyl {508A) __ Other Pesticides (SM18/6630) API _ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) Other:______________________ _ __ Pesticides (525) _ Glycols in Water Refrigerated?yes___ no __ Carbamate F^esticides (531) ..... Acid Extractables (625/8270) __ Glyphosate (547) __ Base Neutral Extractables (625/8270) Chlorinated;?yes no __ Diquat (549) __ GC/MS Unknown Scan

■ Free Chlorine Res;mg/L Total Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) ’■’aioacetic Acids (552) __ Other Pesticides (SM18/6630) _ Phthalates (606MS) __ Other:___ __________ _ _____ _ __________ B I pi __UCMRList1 "■■rADToCHEMICAL AN.At.YS!S „ MtBE Only (524) ! ___ Radon Other.

(NORGANIC ANALYSIS REQUESTED - t.-i Ilf'.. ........ . .. ......... . ..... __ (Acidity __ PotassHJ ..... iMI __ Color __ Aluminum __ 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 __ 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 nini __ Copper __ Solids, Settleable __ Phenol __ Iron .1CI.P __ 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 ... OiiK;i: __ UV254 __ Molybdenum ■t-. _ TCLP-BNAs __ Nickel

NYC-WTC_000074133