Chain of custody record, Sample AE04032, Feb 2002

NYC 9/11 Public Portal Document

■I I ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM .‘stcr WESTCHESTER COUNTY LABORATORIES AND RESEARCH a :a.c4 )fU 2 Dana Road, Valhalla, New York 10595 _ (914)231-1620 Fax (914) 231-1772 J. - , NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01) Pfg ton P I 6UI P Sample Type (circle one): orft-iA.-S- Q /ZSy O iMor ^^^otable 3. Non Potable Treated Boltle «'s: l/fg < ? K < 7?

2. Non Potable 4. Other, Chain of Custody?j Yes No Time/Date Collected:, Collected By: L- Collected From: h _____ Z qn f~-Agency Code:j Coiiiinenis.

FbsI io Source ID:: .Type Descriptor: ■ ■ Location's/lndividual’s Name_ Vi P_________________ : Name/Cornpany Street___ 14 K t L U c ■-//' , ■../ _______ ( Street: .......... City/St/Zip V" - i <1 A Vy y i i? S '1 S City/St/Zip: identification of Source , Phone#:j rax#: Collection Point k... I L H_____________ ________ : CA.CH, Bi? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#:

■I Lab#:_______________________ : ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE SOLID ANALYSIS __ Heterotrophic Plate Count __ ^ihaiomethanes (524) (hemodialysis & all others) __ Purgeable Halocarbons (624/8260) jZWafile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _j>TOlatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) B »iw __ Fecal Coliform (all samples) __ Microscopic __ Total Trihalomethane Potential (510) __ Microextractables (504) __ Pesticides/PCB screen (508) __ Organochlorine Pesticides (608/8081) .... PCB’s (Arochlors) (608/8081) _ Herbicides (SM18/6630,8151) ■i II __ Macroscopic __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) . . API __ Other:______________________ Herbicides (516) __ Petroleum Hydrocarbon Scan (310-13) I Refrigerated?___ _yes___ no Chlorinated:?yes___ no Pesticides (525) __ Carbamate Pesticides (531) .„ Glyphosate (547) __ Glycols in Water _ Acid Extractables (625/8270) _ ^se Neutral Extractables (625/8270) I o .... Diquat (549) ,^,.GC/MS Unknown Scan Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551): Phthalates (606MS) Total Chlorine Res:mg/L: Haloacetic Acids (552) Other:_______ _ _____ _ ______ ______ pH _________ _ ■ „ Other Pesticides (SMI8/6630) II „UCMRList1 ■

RADIOCHEMICAL ANALYSIS __ Radon i _ _ MtBE Only (524)

_ Other______________________ lllillllllillllilllllllllB I INORGANIC ANAi-YSiS KEQULSTED -! I __ Color __ /toidity iminum ^tassium Turbidity Alkalinity itimony u^elenium pH __ Bromide -senic _±|Silver I _ Conductivity __ Bromate/Chlorate/Chlorite iarium dium __ Corrosivity (temp:, .“C) __ Chloride ieryllium allium „ BOD (5 day) __ Cyanide Byon __ Vanadium __ Carbonaceous BOD (b day) Fluoride _K^dmium .=^^inc 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 jeiCChromium, Total __ Volatiles Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent _i2^balt __ Semi-violatiles __ Total Organic Halides Nitrogen, Total Kjeldahl as N _‘i^pper Pesticides/PCB’s Solids, Percent (%) Oil and Grease Solids, Settleable __ Ptienol TCLP Solids, Suspended __ Phosphorus Total as P _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium ..,.,.<T^,anganese __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates .^-f^ercury _ TCLP-Herbicides _ Solids, Total Volatile Surfactants iZ other: :____ __________ _ TCLP-Volatiles _ UV254 _£i4V(^ybdenum __ TCLP-BNAs ._i£^ickel

NYC-WTC_000074175