Chain of custody record, Sample AE04024, Feb 2002

NYC 9/11 Public Portal Document ilMM

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM n\.i (Ui! WESTCHESTER COUNTY LABORATORIES AND RESEARCH a 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108: 5 ■ Time/Date Set; .. ..................... . Form A-70 (rev. 10/01) B 1 Sample Type (cirde one): ....................... i ©Potable : Bottle #s: 3. Non Potable Treated 2. Non Potable 4. Other; Chain of Custody? Yes No; Time/Date Collected: Common!;-. Collected By: i- Uil-jAfrj Ztgency Code: Ptvs /; ; Source iD; Type Descriptor: CcHectcci From: Bill io- I .'.■■a;i,:::’s'in,-ir.;dual’r. Mame . Street i "i P i . ; f Name/Company Street j —I City/Sl/2ip d •_____ tY y__ < c > "h ~: City/Sl/Zip; ■ ■

Identification of Source_______________ _ _________________ Phone#: Fax#: . Collection Point C. A O O r >___________________ ; CA.CH, Bl? Check#: Amounts;

bacteriological ANALYSIS Lab#:: Lab#;- H liBH __ Heterotrophic Plate Count ORGANIC POTABLE ANALYSIS __ Tijhalomethanes (524) ORGANIC NONPOrABLE/SOLID ANALYSIS ..... Purgeable Halocarbons (624/8260) I (her-nodialysis & all others) __ Coliform P/A (Public .supplies) __ Coliform MPN (pnvwell, raw, sip) .jt^latile Halocarbons (524) ^^^YYlatile Aromatics (524) Purgeable Aromatics (624/8260) Acrolein & Acrylonitrile (8260) J __ Fecal Coliform (ail samples) __ Total Trihalomethane Potential (510) „ Organochiorine Pesticides (608/8081) H __ Microscopic __ Microextractables (504) __ PCB's (Arochlors) (608/8081) Pesticides/PCB screen (508) Herbicides (SM 18/6630,8151) ■Bl Macroscopic IHI API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) ilsB __ Other:____________ _ Herbicides (515) __ Pesticides (525) __ Petroleum Hydrocarbon Scan (310-13); _ Glycols in Water I® 1 Refrigerated?yes Chlorinated:? yes no no __ Carbamate Pesticides (531) __ Glyphosate (547) _ Acid Exlractables (625/8270) Base Neutral Exlractables (625/8270) i Free Chlorine Res:, .. mg/L __ Diquat (549) Chlorination Disinfection Byproducts (551): _^Z^C/MS Unknown Scan Phthalates (606MS) o Total Chlorine Res; mg/L __ Haloacetic Acids (552) __ Other:_ ■ i I Other Pesticides (SMI8/6630) pH _____________ _UCMRList1 RADIOCithiWiCAL aNAIYSIS MtBE Only (524) __ Radon „ Other______________________ _

INORGANIC ANAt-YSiS REQUESTED • CtoT?: Color __ Acidity _^AIuminum __ Rotassiu-n __ Turbidity __ Alkalinity o^ntimony __^v..,^ienium pH __ Bromide _ir:^rsenic _r§ilver Conductivity __ Bromate/Chlorate/Chlorite _i?Barium _ Sodium I,- p I Corrosivity (temp:, “C) __ Chloride ..t;-Beryllium .iTrhallium, M n _ BOD (5 day) __ Cyanide __ Boron __ \/anadium Carbonaceous BOD (5 day) „ Soluble BOD (5 day) __ Fluoride __ Hardness, Total as CaCOs j^Gadmium __ Calcium, as CaCOs j/Zinc ■ __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N Calcium, ©Chromium, Total __ Metais/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Total Organic Carbon __ Total Organic Halides Solids, Percent (%) __ Nitrogen, Nitrite as N __ Nitrogen, Total Kjeldahl as N __ Oil and Grease _ (Jhromium, Hexavalent _rcpbait _k<PPPer ___ Volatiles _ Semi-violatiies _ Pesticides/PCB's sOs 18

Solids, Settleabie __ Solids, Suspended __ Phenol __ Phosphorus Total as P ._t.Tron Jk-^ead tclp B _„.TCLP-Metals Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ Solids, Total Dissolved __ Sulfates _©nganese iCLP i’esti.-ides TCLP-Herbicides ■ _ . Sclds. Total Volatile __ Surfactants -'•'Mercury _ TCLP-Volatiles Other: _________ _ UV254 _i^'K'tolybdenum __ TCLP-SNAs „i-4^1ckel ■ NYC-WTC_000074134