Chain of custody record, Sample AE04032, Feb 2002

NYC 9/11 Public Portal Document

' i ■ IBBiBOSIIIIlBl ACClJ^. ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM sU‘r ■ ' " "'I WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 '= 11 NYS-ELAP No, 10108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type (circle one): 1. Potable 3. : Non Potable Treated Bottle #'s; ■■ : 3; 3'3-IP 2. Non Potable 4. Other Chain of Custody? _ Ves No ■ Time/Date Coiiected: Collected By:3 izu Agency Code: •■• L Commeii’s;. . P'-'" " _______ : Source ID:: Type Descriptor: '.'.ollccteel From; Sill to; Location’s/lndividual’s Name 3 .pi ..I ■ Pp Name/Company :

Street_____ ____________ ___ Street: City/SyZip_______________ 3 City/St/Zip: IB Identification of Source____ : Phone#;________ Fax#:: Collection Point___________ ■ I CA,CH. Bi? Check#;: Amounts B BACTERIOLOGICAL ANALYSIS Lab#:^ Lab#;__________________________ : ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) __ Volatile Halocarbons (524) ..... Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv we!!, raw, sip) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (ail samples) __ Total Trihaiornethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microextractables (504) PCB's (Arochlors) (608/8081) __ Microscopic __ Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630.8151) __ PCB as Decachlorobipheny! (508A) __ Other Pesticides (SMI8/6630) . API __ Other:: _ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) _ Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) „ Acid Extractables (625/8270) Chlorinated;? yes no __ Glyphosate (547) Base Neutral Extractables (625/8270): __ Diquat (549) ,3j1 GC/MS Unknown Scan Free Chlorine Res: . mg/L- sOBSSi __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) Total Chlorine Res: .. mg/L __ Haloacetic Acids (552) __ Other:: -- Other Pesticides (SMI 8/6630) pH _____________ _UCMRList1 HADIOCHEMICAt. ANALYSIS __ MtBE Only (524) ___ Radon __ Other___ _ _____ _ ___________ ;

INORGANIC ANALYSIS REQUESTED - Lni-rr __ Color __ A:;idity __ Aluminum __ Potassium Turbidity __ Alkalinity __ Antimony __ Selenium __ pH __ Bromide __ Arsenic „ Silver - A . __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium _ Sodium ;; / _ Corrosivity (temp:: “C): __ Chloride __ Beryllium __ Thallium _ BOD (5 day) _ Carbonaceous BOD (5 day) _ Soluble BOD (5 day) __ Cyanide __ Fluoride __ Hardness, Total as CaCOs __ Boron _Cadmium Calcium, as CaCO; __ Vanadium „ Zinc ’ ■ __ Chemical Oxygen Demand _ Nitrogen, Ammonia as N __ Calcium, Ca"-2 . Metals,CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total __ Volatiles __ Total Organic Carbon Nitrogen. Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles __ Total Organic Halides „ Nitrogen, Total Kjeldahl as N „ Cobalt . .. Pesticides/PCB's Solids, Percent (%) __ Oil and Grease __ Copper Solids, Settieable ___ Phenol __ Iron tclp __ Solids, Suspended __ Phosphorus Total as P __ Lead __TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium .......tclp-Pesticide;.; __ Solids, Total Dissolved __ Sulfates __ Manganese _„TCLP-Herbicides „ Solids, Total Volatile __ Surfactants __ Mercury ___ TCLP-Volatiles __ Other;: ___ UV254 __ Molybdenum _ TCLP-BNAs __ Nickel NYC-WTC_000074177