Chain of custody record, Sample AE04036, Feb 2002

NYC 9/11 Public Portal Document MBH SB®

ENV1RONMEN17KL SERVICES SAMPLE SU3MISSION FORM

a Sier WESTCHESTER COUNTY LABORATORiES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 . NYS-ELAP No. 10108 Tirne/Date SeL Form A-70 (rev. 10/01)

Sample Type (circle one)r 1. Potable 3. Non Potable Treated Bottle #'s:

4. Other_____________ _ Chain of Custody? Yes No 1 2. Non Potable Time/Date Collected:- ____ ComsnonJ*^. 9 Collected By: ___ i Collected r-rom.' ^■1 Agency Code: PWS #:i f’iii tn; Source ID: ■■ Type Descriptor:

■ ■ Location’s/lndividual's Name Name/Company Street______ ___________ Street j City/St/Zip_______________ _ Cily/St/Zip_____ J identification of Source. Collection Point- Phone#:: Fax#: zzzzzzzz^ 8B CA,CH. Bi?' Check#:^ Amounts_________ 1 BACTERIOLOGICAL ANALYSIS Lab#:^ : ?// A SU

Lab#:____, __ Heterotrophic Plate Count (hemodialysis & ail others) __ Coliform P/A (Public supplies) ORGANIC POTABLE ANALYSIS __ Trihalomethanes (524) __ Volatile Halocarbons (524) ; ORGANIC NONPOTABt.E/SOLID ANALYSIS __ Purgeable Halocarbons (624/8260) __ Purgeable Aromatics (624/8260) IB: I _ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Microscopic __ Total Trihalomethane Potential (510) __ Microexfractables (504) __ Organochlorine Pesticides (608/8081) __ PCB's (Arochlors) (608/8081) ■ Macroscopic __ Pesticides/PCB screen (508) Herbicides (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) Other Pesticides (SM18/6630) ■i __ Other:____________________ ___ : __ Herbicides (515) __ Pesticides (525) Petroleum Hydrocarbon Scan (310-13) __ Glycols in Water B i Refrigerated?yes Chlorinated:? yes: no no __ Carbamate Pesticides (531) __ Glyphosate (547) Acid Extractables (625/8270) _ Base Neutral Extractables (625/8270) IB ■ Free Chlorine Res:____ : - mg/L _ Diquat (549) __ Chlorination Disinfection Byproducts (551) C_. GC/MS Unknown Scan __ Phthalates (6U6MS> ■ Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ Other:____________

-pH _____________ _Other Pesticides (SM18/6630) ■ J^ADIOCHEMICAI. ANALYSIS _UCMRList1 _ MtBE Only (524) Si ___ Radon __ Other i ■

IMl INORGANIC ANALYSIS REQUESTED - i ai./r ■Il __ Color _ _ Acidity __ Aluminum __ Potassium Turbidity _ Alkalinity __ Antimony __ Selenium pH __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite .... Barium __ Sodium ; __ Corrosivity (temp:- ’C); __ Chloride __ Beryllium _ Thallium ' / / _ BOD (5 day) __ Cyanide __ Boron Vanadium ' Carbonaceous BOID {5 day) __ Fluoride __ Cadmium Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs rZL::____________—_______ — etP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium. Ca'* _ Metals/CN __ Dissolving Oxygen __ Nitrogen, Nitrate as N __ Chromium, Total . Volatiles __ Total Organic Carbon __ Nitrogen, Nitrite as N Chromium, Hexavalent __ Semi-vioiatiies Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Cobalt __ Pesticides/PCB’s Solids, Percent (%) __ Oil and Grease __ Copper Solids, Settleable __ Phenol __ Iron TCLP _ Solids, Suspended __ Phosphorus Total as P __ Lead __TCLP-Metais _ Solids, Total __ Phosphorus, Ortho as P __ Magnesium _„TCLP-Pesticides __ Solids, Total Dissolved Sulfates __ Manganese __ TCLP-Herbicides Solids. Total Volatile „ Surfactants __ Mercury _ TCLP-Volatiles Other:.. . _ UV254 __ Molybdenum _ TCLP-BNA's Nickel

NYC-WTC_000074200