Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document 1 vH ACCo I ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH * /!/I 2 Dana Road, Valhalla, New York 10595 I (914)231-1620 Fax (914) 231-1772 .'•'NYS-ELAP No. 10108 Time/Date Set: Form A-76 (rev. 10/01) \ 7'6 Sample Type (circle one): i 1. Potable 3. Non Potable Treated Bottle #’s: 2. Non Potable 4. Other___________ Chain of Custody? Yes No Time/Date Collected:: -5 ‘7'7 ' -/ Comments: r.. Collected By:i. Agency Code: PWS #:________ Source ID: Type Descriptor: Collected From: Bill to:

r Location’s/lndividual’s Name J Street_____________________ * / Name/Company Street_________ £ City/St/Zip . ■ City/St/Zip Identification of Source Phone#:_______ Fax#: Collection Point ' b’ CA,CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS Lab#: Lab#: '___________________ ORGANIC NONPOTABLE/SOLID ANALYSIS I ORGANIC POTABLE ANALYSIS _ Heterotrophic Plate Count __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) (hemodialysis & all others) _t_..Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) > -Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) fc __ Fecal Coliform (all samples) __ Microscopic __ Total Trihalomethane Potential (510) __ Microextractables (504) __ Organochlorine Pesticides (608/8081) __ PCB’s (Arochlors) (608/8081)- h __ Macroscopic __ Pesticides/PCB screen (508) __ PCS as Decachlorobiphenyl (508A) _ Herbicides (SM18/6630,8151) _ Other Pesticides (SMI8/6630) I

_ API J; __ Other:_____________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ Glycols in Water Refrigerated?yes no f _ Carbamate Pesticides (531) __ Acid Extractables (625/8270) Chlorinated:? yes___ no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) __ Diquat (549) _j_-GC/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 ___________ _UCMRList 1 RADIOCHEMICAL ANALYSIS __ MtBE Only (524) __ Radon __ Other____________________

I INORGANIC ANALYSIS REQUESTED - Lab#: < ■ __ Color ( __ Acidity _iXAluminum __ Potassium __ Turbidity __ Alkalinity _ : Antimony _i_ Selenium • _ pH __ Bromide __ Arsenic ^'Silver __ Conductivity __ Bromate/Chlorate/Chlorite __ Barium _ Sodium __ Corrosivity (temp:. °C) __ Chloride _2/Beryllium .^'Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride _:_Cadmium ■ .^Zinc _ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs 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 _,Cobalt __ Pesticides/PCB's __ Solids, Percent (%) __ Oil and Grease ■Copper __ Solids, Settleable __ Phenol _^.lron TCLP , __ Solids, Suspended __ Phosphorus Total as P __ -Lead __ TCLP-Metals __ Solids, Total __ Phosphorus, Ortho as P _2_ Magnesium __ TCLP-Pesticides __ Solids, Total Dissolved __ Sulfates _j_-Manganese __ TCLP-Herbicides __ Solids, Total Volatile __ Surfactants Mercury _ TCLP-Volatiles ^■"■Other:'• 1 _ UV254 -Molybdenum __ TCLP-BNA's _.-Nickel

NYC-WTC_000074435