Chain of Custody Record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Docunnent

it ENVIRONMENTAL SERVICES SAMPLE SUBMiSSiON FORM ster I WESTCHESTER COUNTY I.ABORATOPIF5 ANO RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01)

■ Sample Type 1 . Potable 3. Non Potable Treated Bottle #'s:

2. Non Potable 4. Other Chain of Custody? Yes No:

f Time/Date Collected: - __ ____________ Y2_____ _ Comments:

■ Collected By: Collected From: . .... "Y.. , , : Agrnev Code:. .. PWS #:_________ Bill to: Source ^D: Type Descriptor:

Location s/lndividual's Name________ _ _______________ : Name/Company

■ Citv/St/7ip ......................... ................................. City/St/Zip■ I Identification of Source_____________ _ ________________ : Phone#:; Fax#> Collection Point CA,CH, Bl?: Check#:: Amount$J

ill I BACTERIOLOGICAL ANALYSIS Lab#:: Lab#:-

ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) _ Purgeabie Halocarbons (624/8260) il (hemodialysis & ali others) __ Coliform P/A {Public supplies) __ Volatile Halocarbons (524) __ Purgeabie Aromatics (624/8260) __ Coliform MPN (priv well, raw. stp): __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260)

I __ Fecal Coliform (ali samples) __ Microscopic __ Total Trihalomethane Potential (510) __ Microextractables (504) __ Organochiorine Pesticides (608/8081) _ PCB's (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB screen (508) ___ Herbicides (SM18/6630,8151) __ PCB as Decachlorobiphenyl (508A) Other Pesticides (SM18/6630) _ API __ Other:: __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water IBl Refrigerated?yes no __ Carbamate Pesticides (531) __ Acid Extractables (625/8270)

I Chlorinated:?yes___ no Free Chlorine Res:mg/L __ Glyphosate (547) _ Diquat (549) __ Chlorination Disinfection Byproducts (551) __ Base Neutral Extractables (625/8270) _i.u'GC/MS Unknown Scan __ Phthalates (606MS) Total Chlorine Res: rng/L: __ Haloacetic Acids (552) Other:_______________________________ __ Other Pesticides (SM18/6630) pH _____________ __UCMRList1 RADIOCHEMICAL ANALYSIS __ MtBE Only (524) ___ Radon

■■I ^■1 __ Other________________________

2:1 tNORGANiC ANALYSIS REQUESTED - i Hr# ■ __ Color __ Turbidity __ Acidity __ Alkalinity^ VL Aluminum s.-' Antimony __ Potassium Selenium pH __ Bromide Arsenic Silver __ Conductivity __ Bromate/Chiorate/Chlorite Barium __ Sodium __ Corrosivity (temp:: .“C): ___ Chloride __ Beryllium ±_-. Thallium _ BOD (5 day) __ Cyanide __ Boron ... Vanudi.ini ■ __ Carbonaceous BOD (5 day) __ Soluble BOD (5 day) __ Fluoride __ Hardness, Total as CaCOs __ Cadmium __ Calcium, as CaCOa . Zinc ■"cij5 __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, _ Metals/CN __ Dissolved Oxygen __ Nitrogen. Nitrate as N .i^Chromium, Total _ Volatiles US __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Semi-violatiles i __ Total Organic Halides __ Solids, Percent (%) ___ Nitrogen, Total Kjeldahl as N: Oil .Hid Groase .. Cobalt Copper ___ Pesticides/PCB’s __ 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-BNAs .. Nickel

NYC-WTC_000074251