Chain of custody record, Sample AE04032, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 4f T /-I Time/Date Set: i WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772, ? r?? NVS,ELAP NO. 10,08 Ml Form A-70 (rev. 10/01)

Sample Type (circle one)/ <4^otab!e 2. Non Potable 3. Non Potable Treated •4. Other__________ Bottle #’s: Chain of Custody?Yes .. . No lY ■ Time/Date Collected: CnHnc‘-’"d Pyt . AgencvCode: . j Comments:

PWS #:Source ID:Type Descriptor: i■ IB Collected From; Location’s/lndividual’s Name bJ y (J Name/Company ■ MMii Street- IB_ / - Ci Gf_________ I ' - A Street______________ liMB i ciry/st/zip Vo. haU(0 C!ty/St'Z!p M _______ Identification of Source, Phone#:..... ... ........ Fax#:^ ____________ _ Collection Point 'Amounts | CA.CH, Bl? Check#:

BACTCRiOLOGiCAt ANALYSIS Lab#:^ I Lab#;________________ _________ _ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/ .SOLID ANALYSIS __ Heterotrophic Plate Count __ Tphalomethanes (524) __ Purgeable Halocarbons (624/8260) (tiomodialysis & all others) -■''Glatde Halocarbons (524) _ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) _j,^3iatile Aromatics (524) __ Coliform MPN (priv well, raw, sip) __ Acrolein & Acrylonitrile (8260) __ Total Trihaiomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Fecal Coliform (ail samples) __ Microscopic __ Microextracfables (504) PCB's (Arochlors) (608/8081) __ Pesticides/PCB screen (508) Herbicides _ 1 tv;;! ___ MiviuKPO (SM18/6630.8151) tv? __ Macroscopic __ PCB as Decachlorobiphenyl (508A) ....... other Pesticides (SM18,/6630) API __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13), __ Other;________________________ I __ Pesticides (525) Glycols in Water 1! Refrigerated?yes RO __ Carbamate Pesticides (531) __ Acid Extractabies (625/8270) Chlorinated:? .... yes ___ no __ Glyphosate (547) _ Base Neutral Extractabies (625/8270) __ Diquat (549) iZQC/MS Unknown Scan Free Chlorine Res:___ ____ mg/L „Chlorination Disinfection Byproducts (551) __ Phthalates (6L6MS; mmhm■ Total Chlorine Res;; ____ mg/Li ___ Haioacetic Acids (552) __ Other:____________ , .......................... II ■

__ Other Pesticides (SM18/6630) pH _____________

RAOIOCH6MICAL AN ACCS IS _UCMRLisl1 MtBE Only (524) n ___ Radon Bi Other _ _____________________ : ■ INORGANJC ANALYSIS REQUESTED - i nbr Color __ Acidity (^Aluminum __ Potassium." __ Turbidity pH __ Alkalinity __ Bromide j,j^ntimony ^,^■§*616010110 iZ^ilver ' ' 1 __ Conductivity __ Bromate/Chlorate/Chlorite ji^fBarium __ Sodium 1

I __ Corrosivity (temp:. “O __ Chloride j2^eryllium ilium __ BOD (5 day) __ Cyanide __ Boron __ Vanadium Carbonaceous BOD (5 day) ___Fluoride i^Cadmium _ Soluble BOD (6 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs rcLP __ Chemical Oxygen Demand Nitrogen, Ammonia as N .,„U3alcium, Ca*^ Pl^lhromium, Total _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent; __ Semi-violatiles Total Organic Haiides Solids, Percent (%) __ Solids, Settieabie __ Nitrogen, Total Kjeldahl as N __ Oil and Grease __ Phenol i.^rC'obait ipper „ Pesticides/PCB’s I rcLP Solids, Suspended __ Phosphorus Total as P _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P _tognesium _TCLP-Pesticides Solids, Total Dissolved __ Sulfates ..^‘Manganese __ TCLP-Herbicides „_yBolids, Total Volatile _ Surfactants .^t/^ercury iZ Other: __________ __ UV254 J?Molytxienum- -^d^ickel _ TCLP-Volatiles „ TCLP-BNAs ■ NYC-WTC_000074178