Chain of custody record, Sample AE04032, Feb 2002

NYC 9/11 Public Portal Document BOI MH tilBBIIJlSBSOlilllBllilSiiJilillSSBi i ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ester WESTCHESTER COUNTY LABORATORIES AND RESEARCH n\:e( hit IB ■iiiiiiiit 2 Dana Road, Valhalla. New York 10595 (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108: Time/Date Set: Form A-70 (rev. 10/01) z ?7‘ ■. L??: Sample Type ^I.J’otable 3. Non Potable Treated Bo»e2 p lb3 t^lU 2. Non Potable 4. Other ___ _________ : Chain of Custody? Yes No 0 Time/Date Collected:__ : Collected By;

Collected From- L > VAY.tj.jAP C 2.- ip -1 Agency Code:' Coniinefits. PWS #:_________ : Bill io: .. . Source ID: J Type Descriptor:^ lllpl Hill SO IB B Name/Company ■Blii

Street „„___O r . < g____ . Street_________ City/St/Zip \J('a t ha ,___ N "y__ > o S ■ S City/St/Zip• ■ Identification of Source________ _ ______________________ : Phone#:_________ Fax#: Collection Point __________________ CA.CH, Bl? Check#:: Amounts__ _ ____

>5 LCTERIOLOGICAL ANALYSIS Lab#:^ ■ y Lab#:__ ____________________ ___ , ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABt £/SOLID ANALYSIS j __ Heterotrophic Plate Count ihalomethanes (524) _ Purgeable Halocarbons (624/8260) (hemodialysis & ail others) i® __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) jiatile Halocarbons (524) j^olatile Aromatics (524) __ Purgeable Aromatics (624/8260) __ Acrolein & Acrylonitrile (8260) ■ 11 __ Fecal Coliform (ail samples) __ Total Trihalomethane Potential (510) „ Organochlorine Pesticides (608/8081) __ Microscopic Microextractables (504) PCB's (Arochlors) (608/8081) __ Pesticides/PCB screen (508) __ Herbicides (SMI 8/6630,8151) _ Macroscopic __ PCB as Decachlorobiphenyl (SOSA) Other Pesticides (SM18/6630) ■Illi API

■■ I .. .. Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13): __ Other:_______________________ : __ Pesticides (525) __ Glycols in Water Refrigerated?yes___ no __ Carbamate Pesticides (531) Acid Extraclables (625/8270) ■lii ■Is JI Chlorinated:? yes no __ Glyphosate (547) __ Base Neutral Extractabies (625/8270) _Diquat (549) jc/^C/MS Unknown Scan Free Chlorine Res:mg/L * Total Chlorine Res:mg/L __ Chlorination Disinfectio.n Byproducts (551) __ Haloacetic Acids (552) .. .. Phthalates (606MS) __ Other:, I pH_____________ Other Pesticides (SMI8/6630) _UCMRList1 ■ ■■I RAUIOCHLMICAi. ANALYSIS _ MtBE Only (524) Radon __ Other_________ ______________ _ - S!'>QRGANIC analysis REQUesSED ■ i __ Color Acidity uminum __ Potassium Turbidity __ Alkalinity itimony _>^elenium __ pH __ Bromide rsenic .♦■Silver Conductivity __ Bromate/Chlorate/Chlorite arium _^ium. , : __ Corrosivity (temp:, .’C)' __ Chloride i/beryllium ■■Thallium BOD (5 day) __ Cyanide ___^ron __ Vanadium Carbonaceous BOD (5 day) __ Fluoride jZCadmium jZzinc Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N _ Calcium, Ca*2 ji^hromium. Total „ Metals,fCN __ Dissolved Oxygen __ Nitrogen, Nitrate as N _ Volatiles Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent , Xlobalt __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Pesticides/PCB’s ___ Solids, Percent (%) __ Oil and Grease pper __ Solids. Settleable __ Phenol n rCLp Solids, Susoended __ Phosphorus Total as P .^Ztead _TCLP-Melals __ Solids, Total Phosphorus. Ortho as P Jnfaqnesium _ TCLP-Pesticides Solids, Total Dissolved __ Sulfates .■Manganese „ _ S&lids, Total Volatile __ Surfactants J:^Wrcury _TCLP-Herbicides TCLP-Volatiles ■ i^^Other:____SQ_____ : __ UV254 □■^ybdenum TCLP-BNA’s .JjrNicke!

NYC-WTC_000074176