Chain of custody record, Sample AE04028, Feb 2002

NYC 9/11 Public Portal Document

MB 11 . . ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM I I /I WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla. New York 10595 (914) 231-1620 Fax (914) 231-1772 ,/• i/neiaot i V,____ NYS-ELAP No. /OMia Time/Date Set: pr-R p- ibtyp p ?8^ FormA-70 (rev. 10/01);

Sample Type (circle one):: Gre - 5^'6 O'SW/? 6876? Non Potable Treated Bottle #’s: C jS S OX'B gBj ■ Chain of Custody?Yes No B- JS B 2. Non Potable 4 Othor................................ Time/Date Collected:I Connncnts: IB Collected By; Agency Code: _i _ Source ID:Type Descriptor: Collected From; Location’s/lndividual’s Name Byt--____________ i Bin to: Name/Company i ■I Street,____ J_________ Street_______ _ City/St/Zip i ____ Wm lid, mm Identification of Source_______________ _ ________ _ ________ Phone#; Fax#: i i ■i Collection Point CL Z, (_ LmJGI_____________ : Check#:! CA,CH, Bl? „ Amounts I

BACTERIOLOGICAL ANALYSIS Lab#: : Lab#:! i ORGANIC POTABLE ANA(.YS.S ORGANIC NONPO FABLE/SOUQ ANALYSIS __ Heterotrophic Plate Count _^halornethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & al! others) Z/j/alatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (privwell, raw, stp) _±ivolatiie Aromatics (524) __ Acrolein & Acrylonitrile (8260) (|8 __ Fecal Coliform fail samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microextractables (504) PCB’s (Arochlors) (608/8081) __ Microscopic Macroscopic „ API __ Pesticides/PCB screen (508) __ PCB as Decachlorobiphenyl (508A) _ Herbicides (SM18/6630.8151) __ Other Pesticides ISM 18/66301 1^1 wi __ Other:i

Refrigerated?yes___ no __ Herbicides (515) __ Pesticides (525) __ Carbamate Pesticides (531) __ Petroleum Hydrocarbon Scan (310-13) __ Glycols in Water __ Acid Extractables (625/8270) ■ __ Glyphosate (547) __ Base Neutral Extractables (625/8270) Chlorinated;?yes Free Chlorine Res;mg/L no __ Diquat (549) X^C/MS Unknown Scan fl Total Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) Phthalates (606MS) __ Other: ■ Other Pesticides (SM18/6630) B -pH ------------------- ----------------------- _UCMRLisl1 ■ RADIOCHEMICAL ANALYSIS __ Radon __ Other; MtBE Only (524) i INORGANIC / NALYSIS REQUESTED - i.-.HA' I Color __ Acidity Aluminum __ ^ptassium ■ Turbidity __ Alkalinity .jZ^Antimony ^ZSeienium pH Conductivity __ Bromide __ Bromate/Chlorate/Chlorite -JYtBrsenic _Z^lver ■MH ■ _jEf™rium ___Spdium ' Corrosivity (temp:, ’C) __ Chloride -Beryllium .ZThallium 3 _ BOD (5 day) __ Carbonaceous BOD (5 day) __ Soluble BOD (5 day) Cyanide __ Fluoride __ Hardness, Total as CaCOa _ .X’ron XCadrnium __ Caicium, as CaCOs __ Vanadium tBZinc 1 ■ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ ^Icium, Ca*2 □.B/hromium, Total _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N _ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N ___ CJjromium, Hexavalent __ Semi-vioiatiies Total Organic Halides __ Nitrogen, Total Kjeldahl as N bait __ Pesticides/PCB's Solids, Percent (%) Solids, Settleable __ Oil and Grease __ Phenol PPer ■ TCIP Solids, Suspended __ Phosphorus Total as P ..•■'lead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ lyjagnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates .Z^nganese __ TCLP-Herbicides _ _ Solids, Total Volatile __ Surfactants _jMClercury .iZ Other: SA_________ : _ TCLP-Volatiies ___ UV254 _fcH0olybdenum . TCLP-BNAs ^Zf^ickel Hi NYC-WTC_000074154