Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document ■'S

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM >>» ACCn * lA^^tchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH ?! 2 Dana Road, Valhalla, New York 10595 I (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.10/01) I r •s Sample Type (circle one): ’ 1. Potable Bottle #'s:

1 3. Non Potable Treated * 2. Non Potable I 4. Other_____________ Chain of Custody?___ Yes____ No Time/Date Collected: i- Comments: Collected By: ’/

I Collected From: Agency Code: PWS #:_______ Bill to: Source ID: Type Descriptor: ‘ 1. 1 II j Location’s/lndividual’s Name Name/Company t I r 1 Street -------------------------- Street_________ City/St/Zip________________ City/St/Zip Identification of Source 'Phone#: Fax#: I ) Collection Point ! J 6' CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#: 4 Lab#:__________________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS j_ Heterotrophic Plate Count , (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) _ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) > Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) I 2_ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) , J_ Microscopic __ Microextractables (504) _ PCB's (Arochlors) (608/8081) ■ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SMI8/6630,8151) I API __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SMI 8/6630) ! __ Other:_______________________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13)

I I __ 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) __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) ■st pH _____________ __ UCMR List 1 RADIOCHEMICAL ANALYSIS _MtBEOnly (524) __ ^Radon __ Other________________________ 3 fii’ INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity __ Aluminum __ Potassium J_ Turbidity __ Alkalinity __ Antimony __ Selenium pH __ Bromide _ Arsenic _i_. Silver I Conductivity __ Bromate/Chlorate/Chlorite __^Barium __ Sodium J. _L Corrosivity (temp: .°C) __ Chloride Beryllium __ Thallium / ■

. BOD (5 day) __ Cyanide __ Boron __ Vanadium _L. Carbonaceous BOD (5 day) __ Fluoride __ Cadmium - 'Zinc __ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOa CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, 'Ca*2 __ Dissolved Oxygen _ Metals/CN __ Nitrogen, Nitrate as N _Chromium, Total __ Total Organic Carbon __ Volatiles __ Nitrogen, Nitrite as N __ Chromium, Hexavalent ! __ Total Organic Halides __ Semi-violatiles __ Nitrogen, Total Kjeldahl as N __ Cobalt * __ Pesticides/PCB’s _ Solids, Percent (%) __ Oil and Grease __ Copper , 1 Solids, Settleable _ Solids, Suspended _L Solids, Total _ Solids, Total Dissolved __ Phenol __ Phosphorus Total as P __ Phosphorus, Ortho as P I* __ Iron __ ‘Lead __ Magnesium TCLP _TCLP-Metals __ TCLP-Pesticides t

1 __ Sulfates __ Manganese Solids, Total Volatile __ TCLP-Herbicides _ Surfactants __ Mercury Other: ■____________ __ TCLP-Volatiles _ UV254 __ Molybdenum ■ _ TCLP-BNA’s I Nickel

NYC-WTC_000074479