Chain of custody record, Sample AE04036, Feb 2002

NYC 9/11 Public Portal Document — •

ENVIRONMENTAL SERVICES SAMPLE SUBMiSSiON FORM II YAT-OHi WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Read, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 illTime/Date Set? ’ Form A-70 (rev. 10/01)

I 111® Sami . Potable le (circle one):

'otable 3. Non Potable Treated 4. other _____________________ ■ Xi Chair of C:!C*'''L'? Yc's No , ' ■ • / ' J Time/Date Collected: W * rpoZ Comments: ■

o Collected By: L/ • '______ Agency Code: PWS #: Source ID: 'fype Descriptor: :|BI ■ (. uilc-cicd From: Location’s/lndividuai's Name__ Ll^S.__ _________ “Xi.?'?' ?;?' <.. - I Street Street 1 I City/St/Zip v® L.J/ ft L <- Q t rg j-T: \T'{ ?>.

Identification of Source i; Phone#: Fax#? _______________ Collection Point___________________________________ _ CA,CH, Bi? Check#? Amounts___ ■ BACTERIOLOGICAL ANALYSIS Lab#:__________________________ Lab#? AW 5 V MB ORGANIC POTABLE ANALYSIS " ORGANIC NONPOTABLC/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & ail others) __ Trihaiomethanes (524) Purgeabie Halocarbons (624/8260) I Z>Volatile Halocarbons (524) '? __ Purgeabie Aromatics (624/8260) __ Coliform P/A (Public, supplies) __ Coliform MPN (priv well, raw, stp) >i®Volatiie Aromatics (524) __ Acrolein & Acrylonitrile (8260) ■ __ Fecai Coliform (ail samples) __ Microscopic __ Total Trihaiornethane Potential (510) __ Microextractabies (504) __ Organochiorine Pesticides (608/8081) PCB's (Arochlors) (608/8081) ■ s __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630.8151) _ API __ PCB as Decachlorobiphenyl (508A) Other Pesticides (SM18/6630) __ Other:( __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) ■ Refrigerated?yes no __ Pesticides (525) __ Carbamate Pesticides (531) Glycols in Water Acid Extractables (625/8270) 1! Chlorinated:? yes no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) __ Diquat (549) z ,, GC:MS Unknown Scan Free Chlorine Res:____, - mg/L _ Chlorination Disinfection Byproducts (551); __ Phthalates (606MS) Total Chlorine Res:j . mg/Li __ Haioacetic Acids (552) __ Other:________________ _ ____ ____ Other Pesticides (SM18/6630) pH --------------------- UCMR List 1 RADIOCHEMICAL ANALYSIS . „ MtBE Only (524) _.Radon „ Other.

h^iORGANIC ANAi.ySiS REQUESTED i.;?;#!■ __ Color ■ __ Acidity Aluminum __ Potassium __ Turbidity pH __ Conductivity __ Alkalinity __ Bromide _ Bromate/Chiorate/Chiorite Antimony Arsenic < Barium X-Selenium

' A, . 1 __ Corrosivity (temp:. ?C): Chloride 2y Beryllium 2j< Thallium . BOD (5 day) __ Carbonaceous BOD (5 day) __ Cyanide __ Fluoride __ Boron jSCadtnium __ Vanadium y. Zinc I „ Soluble BOD (5 day) __ Chemical Oxygen Demand __ Hardness, Total as CaCOa __ Nitrogen. Ammonia as N __ Calcium, as CaCOa __ Calcium. C.i i __ Dissolved Oxygen ___ Total Organic Carbon __ Nitrogen, Nitrate as N __ Nitrogen, Nitrite as N .^Chromium, Totai _ Chromium, Hexavalent _ Metals/CN __ Volatiles ■ ■ __ Semi-violatiles __ Totai Organic Halides __ Nitrogen, Total Kjeldahl as N Cobalt I __ Pesticides/PCB's __ Solids, Percent (%) __ Oil and Grease .^Copper __ Solids, Settleable __ Phenol jL Iron tclp ■I __ Solids, Suspended __ Phosphorus Totai as P 2YLead _TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium i ■ __ TCLP-Pesticides Solids, Totai Dissolved __ Sulfates /;?sManganese _ TCLP-Herbicides Solids, Totai Vplatile Surfactants Mercury ___ TCLP-Voiatiles X Other:________Jj_________; _ UV254 7- ■ Molybclenum . TCLP-BNAs V Nickel a NYC-WTC_000074199