Chain of custody record, Sample AE04028, Feb 2002

NYC 9/11 Public Portal Document sis

OS 1*4 ' ■ Sti EKVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM stcr I J WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 O «! ■I NYS-ELAP No. 10108 TimeZDate Sets Form A-70 (rev. 10/01)

Sample Type (circle one)? I. Potable 3. Non Potable Treated Bottle #'ss Tn.. Chain of Custody?___ Yes No IS 2. Non Potable 4. Other ________ : Is Time/Date Collected:_______ i __ ---____________ __ Coininents: IB C. " ■ ■~ Agency Code: PWS #:. Source ID:- Type Descriptor: J r ultcclRCi From: Location’s/lndividual’s Name Bi!i to: Name/Company: ■■ Street____________ _____ Street : * City/St/Zip______________ City/St/Zip i Identification of Source___ , Phone#: Fax#: Collection Point_________ , iU»Mi CA,CH, Bi?^ Check#:! Amounts j

5ACTERIOI.OGICAL. ANALYSIS Lab#: ■ Lab#:_______________________ : ORGANIC POTABLE .ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) . Purgeable Halocarbons (624/8260) (hemodialysis & al! oihers) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) Organochiorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) PCB’s (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SM18/6630) ___ API iiB- __ Other:____________________ _ __ Herbicides (515) __ Pesticides (525) __ Petroleum Hydrocarbon Scan (310-13) __ Glycols in Water ■■ ■I Refrigerated?yes no __ Carbamate Pesticides (531) Acid Extractabies (625/8270) Chlorinated:? yes___ no __Glyphosate (547) Base Neutral Extractabies (625/8270) __ Diquat (549) .Y 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 (SMI 8/6630) pH ------------------- __UCMRList1 ___ MtBE Only (524) ■ RADIOCHEMICAL ANALYSIS __ Radon __ Other____ :

SNOFxGANIC ANALYSIS REQUESTED -1 .m#.! __ Color __ Acidity __ Aluminum __ Potassium __ Turbidity Alkalinity __ Antimony __ Selenium pH __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chiorite __ Barium __ Sodium __ Corrosivity (temp:. “C) __ Chloride __ Beryllium __ Thallium „ BOD (5 day) __ Cyanide __ Boron __ Vanadium Carbonaceous BOD (5 day) _ Soluble BOD (5 day) __ Fluoride __ Hardness, Total as CaCO:i __ Cadmium __ Calcium, as CaCOa __ Zinc ■ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total _ Metals/CN __ Volatiles I Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent- Semi-violatiles __ Total Organic Halides __ Nitrogen. Total Kjeldahl as N __ Cobalt _ Peslicides/PCB’s __ Solids, Percent (%) __ Oil and Grease __ Copper Solids, Settleable __ Phenol __ Iron TCi,P Solids, Suspended __ Phosphorus Total as P __ Lead _TCLP-Metals Solids, Total __ Phosphorus, Ortho as P __ Magnesium __TCLP-Peslicides Solids, Total Dissolved __ Sulfates __ Manganese __ TCLP-Herbicides Ml Solids, Total Volatile Surfactants __ Mercury TCLP-Volatiles Other:___ _ _______ _____ _ UV254 __ Molybdenum _ TCLP-BNAs __ Nickel —- ----- IO MHM NYC-WTC_000074153