Chain of custody record, Sample AE04125, Feb 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 3ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH ?l 2 Dana Road, Valhalla, New York 10595 <: a» * o (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108; Time/Date Set? Form A-70 (rev.10/01)

Sample Type (circle one)? llillllil Bottle #’s: 1. Potable 3. Non Potable Treated 31 2. Non Potable 4, Other Chain of Custody?: Yes No; Time/Date Collected: IIBBI ■IIB Comments; Collected By: IBI Agency Code: PWS #:; Source ID: Type Descriptor: Collected From; Bill to: Location's/lndividual’s Name Name/Compary Street__________ _ _________ _ Street; City/St/Zip. City/St/Zip Identification of Source Phone#:: Fax#: Collection Point________» CA,CH, Bi? Check#: Amounts;

BACTERIOLOGICAL ANALYSIS Lab#: ■ Lab#:_____ _____________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTA8LE/ SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) Purgeable Halocarbons (624/8260) (hemodialysis & ail others) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, sip)- __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (.all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) ___ Microscopic __ Microextractables (504) _ PCB's (Arochlore) (608/8081) Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8151) __ API __ PCB as Decachlorobiphenyl (608A) „ Other Pesticides (SMI8/6630) __ Other: j __ 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) III __ Diquat (549) __ GC/MS Unknown Scan Sil Free Chlorine Res:’ - mg/L __ Chlorination Disinfection Byproducts (551) Phthalates (606MS) III Total Chlorine Res:, mg/L; Haloacetic Acids (552) __ Other:.__________ ______________ _Other Pesticides (SM I 8/6630) __ UCMR List 1 RADIOCHEMICAL ANALYSIS MtBE Only (524) __ Radon Other :

tNORGANiC ANALYSIS REQUESTED -1 air? __ Color __ /Acidity __ Aluminum __ Potassium __ Turbidity __ Alkalinity __ Antimony Selenium pH __ Bromide __ .Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium __ Sodium ■11 __ Corrosivity (temp:: °C) __ Chloride __ Beryllium Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) Fluoride __ Cadmium ,.--'2inc __ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOa __ , Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca+2 __ Dissolved Oxygen __ Metals/CN __ 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 __ Peshcides/PCB's __ Solids, Percent (%) _ Oil and Grease Copper __ Solids, Settleable __ Phenol _ Iron TCLP __ Solids, Suspended __ Phosphorus Total as P _ Lead -._TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P __ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates __ Manganese _ TCLP-Herbicides _ Solids, Total Volatile „ _ Surfactants _2_ Mercury __ Other:j __ TCLP-Volatiles _ UV254 __ Molybdenum _ TCLP-eNA’s __ Nickel

NYC-WTC_000074225