Chain of custody record, Westchester County Lab, Feb 2002

NYC 9/11 Public Portal Document J L '•f ENVIRiONMENTAL SERVICES SAMPLE SUBMISSION FORM iMfestchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 I (914) 231-1620 Fax-(914) 231-1772 if NYS-ELAP No. 10108, Time/Date Set: Form A-70(rev.10/01) 3 /? ' I 'Sample Type (circle one): r 1. Potable 3. Non Potable Treated Bottle #’s; 1 2. Non Potable 4. Other Chain of Custody?___ Yes No i Time/Date Collected: : Collected By: - ■ ' ■' Agency Code: Comments: PWS #:_____ _ Source ID: Type Descriptor?. i Collected From: Bill to: Location’s/lndividual’s Name Name/Company ' Street________ _________ Street_______ City/St/Zip______________ City/St/Zip 'A .Ti Identification of Source Collection Point Phone#:

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

Amounts. I -I BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS' ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) i __ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260) ' __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) , t __ Fecal Coliform (all samples) _ Total Trihalomethane Potential (510) __ Microextractables (504) __ Organochlorine Pesticides (608/8081) • _ PCB’s (Arochlors) (608/8081) I I? I __ Microscopic ' __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,8151) "‘S' ; _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI8/6630) 1 ■

1 __ Other:_______________ __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13)

Refrigerated?yes no __ Pesticides (525) __ Glycols in Water 4 1 __ Carbamate Pesticides (531) _ Acid Extractables (625/8270) I Chlorinated:? yes no __ Glyphosate (547) __ .Base Neutral Extractables (625/8270) I __ Diquat (549) GC/MS Unknown Scan '1 Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) ••4 _ Phthalates (606MS) 1 Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ Other Pesticides (SMI8/6630) __ Other:_____________ « pH ___________ _UCMRList1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) . L __ Radon T’

__ Other____________________ -' •; ■ —J 1

INORGANIC ANALYSIS REQUESTED - Lab#: I __ Color __ Acidity J_ Aluminum __ Potassium' __ Turbidity __ Alkalinity __ Antimony __ Selenium j ‘5 _ pH __ Bromide __ Arsenic __ Silver // 1 __ Conductivity __ Bromate/Chlorate/Chlorite _ Barium __ Sodium Y __ Corrosivity (temp:. °C) __ Chloride __ Beryllium __ Thallium ' _ BOD (5 day) I __ Carbonaceous BOD (5 day) __ Cyanide __ Fluoride __ Boron .;__Cadmium __ Vanadium __ Zinc I __ Soluble BOD (5 day) __ Hardness. Total as CaCOa __ Calcium, as CaCOa J __ Chemical Oxygen Demand CLP s __ Nitrogen. Ammonia as N __ Calcium, Ca*2 I __ Dissolved Oxygen _ Nitrogen. Nitrate as N _ Metals/CN __ Chromium. Total ! __ Total Organic Carbon __ Volatiles __ Nitrogen. Nitrite as N __ Chromium. Hexavalent __ Total Organic Halides __ Semi-violatiles __ Nitrogen. Total Kjeldahl as N __ Cobalt __ Solids. Percent (%) __ Pesticides/PCB’s^ __ Oil and Grease __ Copper I __ Solids. Settleable __ Phenol __ Iron '! TCLP __ Solids. Suspended __ Phosphorus Total as P __ Lead __ Solids, Total __ TCLP-Metals __ Phosphorus. Ortho as P __ Magnesium __ Solids, Total Dissolved __ TCLP-Pesticides __ Sulfates __ Manganese __ Solids, Total Volatile __ TCLP-Herbicides __ Surfactants __ Mercury __ Other: _____________ _ TCLP-Volatiles ' _ UV254 __ Molybdenum I _ TCLP-BNA’s __ Nickel

NYC-WTC_000074483