Chain of custody record, Sample AE04028, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM BIIIIIIIIBlBllllllllllllOilBIOIIlSBIIIllillllBIIIIIIIBBillllllllB® Ml ACCo I ■ WESTCHESTER COUNTY I APORATOPIES AND RESFARCU 2 Dana Road, Valhalla, New Ytork 10595 (914)231-1620 Fax (914) 231-1772 1 NYS-ELAP No. 10108 Time/Date Set: FormA-70 (rev. 10/01

Sample Type (circle one); Bottle #-s: ; G ;/ .Sb, Z ri T I ■■ 3. Non Potable Treated 2. Non Potable 4. Other; Chain of Custody? Yes No Time/Date Collected: GemiiionIs- Collected By: L- ■ VMriqAr f Agency Code:; PWS #:________ _ Source ID: J Type Descriptor; I Coiicuted Fioin; Bill to: ' .s.-at;o-ri/'i !dividiini’s Name . . M B- . A . .. Name/Company „ Street V' t j/M ■" S i i cx U f____ 0 r . y r_______ ; Street; City/St/Zip Vuih/iU ■__ y_______ h ; \ T S

Identification of Source___ ,_____ ______________________ ; Phone#;_______ _ Fax#: Collection Point._ AU _______ _ CA.CH, Bi?; Check#; .. Amounts. Illi SAC rERIOLOGICAL ANAi YSIS Lab#: ___________________________ Lab#:

U,s - I __ Heterotrophic Plate Count (hemodialysis & ail others) ORGANIC POTABLE ANAI __ ^halomethanes (524) ORGANIC NON POTABLE/SOi.lD ANALYSIS __ Purgeable Halocarbons (624/8260) ri ,.,z^atile Halocarbons (524) Purgeable Aromatics (624/8260) ___ Coliform P/A (Public supplies) ..^^■^latile Aromatics (524) __ Coliform MPN (priv well, raw, stp) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) Organochlorine Pesticides (608/8081) __ Microextractabies (504) PCB’s (Arochlors) (608/8081) __ Microscopic Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,8151) __ PCB as Decaclilorobiphenyl (508A) Other Pesticides (SMI8/6630) API __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) ■! __ Other:_________ _ ____________ .

Refrigerated?yes no __ Pesticides (525) __ Carbamate Pesticides (531) __ Glycols in Water Acid Extractables (625/8270) i Chlorinated:? yes no __ Glyphosate (547) ....... Base Neutral Extractables (625/8270) i Diquat (549) .«<GC/MS Unknown Scan Free Chlorine Res: - !Tig/L

Total Chlorine Res: mg/L __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) Other Pesticides (SMI8/6630) _ Phthalates (606MS) Other;...................................... I pH ---------------------

RADIOCHEMICAL ANALYSIS: _UCMRList1 _ MtBE Only (524) I __Radon _ Other______________________ :

INORGANIC ANALYSIS REQUESTED - LaiA- I __ Color __ Turbidity pH _ Acidity __ Alkalinity _ Bromide jz^uminum -JrfAntimony .^Zl^rsenic __ _ Potassium

slriB i■ __ Conductivity _ Corrosivity (temp:. .“C) Bromate/Chlorate/Chlorite __ Chloride ,>:S^rium jZBeryllium Cydinni „.:Yfhal!ium g IB __ BOD (5 day) __ Cyanide __ Boron __ Carbonaceous BOD (5 day) __ Fluoride u^admium _..^2inc __ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N _ Calcium, Ca*^ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N jZChromium, Total __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Solids, Percent (%) __ Oil and Grease ibalt >per _ Pesticides/PCB’s I® III __ Solids, Settieable __ Phenol TCLP __ Solids, Suspended __ Solids, Total __ Solids, Total Dissolved __ Phosphorus Total as P _ Phosphorus, Ortho as P __ Sulfates .iXtoad __ Magnesium ^Wnganese __ TCLP-Metals _ TCLP-Pesticides ■ ■ __TCLP-Herbicides __ Splids, Total Volatile __ Surfactants __YMgrcury _ TCLP-Volatiies ■ XliiiHr: SA__________ ; ___ UV254 _H^iybdenum ■SS L,4<ickel _ TCLP-BNAs i NYC-WTC_000074156