Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document i f

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

Sr®" WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 V NYS-ELAP No. 10108 I 1 Time/Date Set: f’r. f ' Form A-70 (rev.10/01)

Sample Type (circle one): Oi 'i Q ■/V € 3. Non Potable Treated Bottle #’s: ' 2. Non Potable 4. Other Chain of Custody?___ Yes No ‘ Time/Date Collected: i 2-^S Y •/ Comments: Collected By: L- H / Agency Code: PWS #:______ Source ID: Type Descriptor:

I" e Collected From: j Location’s/lndividual’s Name i Street VN P M ’y f ‘ i I i Ur Of » L Bill to: Name/Company Street________ City/St/Zip City/St/Zip fe. I pt- Identification of Source Collection Point Phone#:

CA,CH, Bl? Check#: Fax#:

Amounts L- h' BACTERIOLOGICAL ANALYSIS Lab#:_______________________ Lab#:

ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) ;---Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (privwell, raw, stp) .^Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) ■__ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) '__ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) :__ Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8151) __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630) i_ API _ Other:____________________ __ 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) __ Diquat (549) jX^C/MS Unknown Scan , Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other:_________________________ __ Other Pesticides (SM18/6630) pH ____ _______ __ UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBEOnly (524) __ Radon _ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#: 4 Z' _ Color __ Acidity LZ’Aluminum __ Potassium __ Turbidity __ Alkalinity j;:^ntimony ■--•'Selenium !' — __ Bromide _i£r'^rsenic i-.-^Silver __ Conductivity __ Bromate/Chlorate/Chlorite ^Barium __ Sodium __ Corrosivity (temp:. °C) __ Chloride _^Beryllium u/Thallium ' _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride _xCadmium ■XZinc : _ Soluble BOD (5 day) __ Hardness, Total as CaCOa __ Calcium, as CaCOa CLP ■ __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ _ Metals/CN < __ Dissolved Oxygen __ 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 j^Cobalt __ Pesticides/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 ■ -z'Manqanese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants ■-'Mercury __ TCLP-Volatiles : JrrZ^Other: ___________ _ UV254 ' - Molybdenum _ TCLP-BNA’s Nickel

NYC-WTC_000074410