Chain of custody record, Sample AE04036, Feb 2002

NYC 9/11 Public Portal Document

■111 \I * ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Jk'sicr WESTCHESTER COUNTY LABORATORIES AND RESEARCH ■YCsIlti 2 Dana Road. Valhalla, New York 10595 i.,/ * (914) 231-1620 Fax (914) 231-1772 V NYS-ELAP No. 10108 lime/Date Set: f"'" ! P W'.i: Form A-70 {rev.10/01)

Sample Type (circle one): or/3 l3Ob. ^l^otable 3. Non Potable Treated Bottle #s: £> lO 2. Non Potable 4. Other, Chain of Custody?Yes___ No I Time/Date Collected: j A??' A O_____ z. ■ AV CommmUs: _______ Collected By: Agency Code:; PWS #: _______ Source ID: Type Descriptor; ■ Collected From; Oil! to:

Location's/lndividual’s Name j nyg rirP____ Name/Company: Street__Vv g \ I U-i-At_______ (A . J(____ _ _____ _ Street. City/St/Zip__ jZilXAALL.;____ N M___ j;' AAi______ City/St/Zip J Identification of Source; Phone#:, Fax#::

Collection Point,_________________ _ OBW CA.CH, Bi? Check#:Amounts

BACTERIOLOGICAL ANAL VSiS Lab#:__________ _______________ _ Lab#:

ORGANIC POTABLE ANALYSIS organic nonpotable/solid analysis ■ I __ Heterotrophic Plate Count (hemodialysis & ail others) __ Coliform P/A (Public supplies) __ TOhaiomethanes (524) jGf^latile Halocarbons (524) _;£<%latiie Aromatics (524) __ Purgeable Halocarbons (624/8260) __ Purgeabie Aromatics (624/8260) __ Acrolein & Acrylonitrile (8260) ■■ i __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Orqanochlorine Pesticides (608/8081) _ PCB's (Arochlors) (608/8081) 1 __ Microscopic __ Microextractables (504) __ Pesticides/PCB screen (508) Herbicides (SM18/6630,8151) I® __ Macroscopic _ API __ Other:. __ PCB as Decachlorobiphenyl (508A) __ Herbicides (515) __ Pesticides (525) „ Other Pesticides (SM18/6630) __ Petroleum Hydrocarbon Scan (310-13) __ Glycols in Water — i I Refriger.ated?yes no __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) Chlorinated:?yes no „ Glyphosate (547) Diquat (549) _ Base Neutral Extractables (625/8270) _i<GC/MS Unknown Scan ' I Free Chlorine Res:. Total Chlorine Res:; -mg/L . mg/L; __ Chlorination Disinfection Byproducts (551)- __ Haloacetic Acids (552) Phthalates (606MS) __ Other:_______________________________ ■■ I pH _____________

radiochemical analysis __ Other Pesticides (SM18/6630) __UCMRList1 _ MtBE Only (524) 1 ___ Radon __ Other_______________________ __

iNORGANiC ANALYSIS REQUESTED - I..1I)# __ Color __ Acidity Juminum __ Potassium UBIB ■■ i __ Turbidity _ Alkalinity ..Z^^ntimony IB

Ia pH __ Bromide -ti^rsenic Conductivity __ Bromate/Chlorate/Chlorite JoBarium __ Sodium ■ / Corrosivity (temp:( ?C); __ Chloride r/ Beryllium jAihallium A / _ BOD (5 day) __ Cyanide __ ^oron __ Vanadium ' Carbonaceous BOD (5 day) __ Fluoride jZCadmium .ii(^inc Soluble BOD (5 day) __ Hardness, Total as CaCO3 __ Calcium, as CaCO;; __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ palcium, Ca*’ ___ Metals/CN ■ r/fchromium, Total __ Dissolved Oxygen Total Organic Carbon __ Nitrogen, Nitrate as N __ Nitrogen, Nitrite as N ..Chromium, Hexavalent: __ Volatiles _ Semi-violatiles I Total Organic Halides __ Solids, Percent (%) __ Solids, Setdeabie __ Nitrogen, Total Kjeldahl as N __ Oil and Grease __ Phenol ..jp^opper -ifJfon Pesticides/PCB's I I TCLP __ Solids, Suspended __ Phosphorus Total as P -^ifLead „TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium j-^langanese _TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates ji^ercury _TCLP-Herbicides: Solids, Total j/olatile „ Surfactants ,_Z Other; _ ______ ___ UV254 jCjStolybctenun .JiZNickel ~ TCLP-Volatiles TCLP-BNA's 1 IB 111 NYC-WTC_000074197