Chain of Custody Record, Westchester County Lab, Mar 2002

NYC 9/11 Public Portal Document t 1 ACCo ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 4; /I 1 (914)231-1620 Fax (914) 231-1772 NYS-ELAP No: 10108 Time/Date Set; Form A-70 (rev.10/01)

Sample Type (circle one): (l.'Potable 3. Non Potable Treated Bottle #’s: f- CZAc. i.Z • b .tZ' A

2. Non Potable 4. Other___________ Chain of Custody? Yes No Time/Date Collected: (/Hi O '"i - Z f ci Comments: Collected By: L Agency Code: PWS #:________ Source ID: Type Descriptor: I. 1 Collected From: Bill to: Location’s/lndividual’s Name i v V/ C. L.1 ■ > Name/Company - Street t i U. c C (7 M,- br . I ; / Street_________ I City/St/Zip ! A. t City/St/Zip Identification of Source Phone#:_______ Fax#; Collection Point <. -'•’1 r' / / CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS :__ Heterotrophic Plate Count - (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) ^XZolatile Halocarbons (524) __ Purgeable Aromatics (624/8260) ' __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) ^K/oiatile Aromatics (524) __ Acrolein &‘Acrylonitrile (8260) __ Fecal Coliform (ail samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) _ PCB’s (Arochlors) (608/8081) _ Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SMI8/6630,8151) ' __ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI8/6630) __ Other:_____________________ __ Herbicides (515) 1 __ 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) _i^6c/MS Unknown Scan Free Chlorine Res: . mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) Total Chlorine Res: . mg/L __ Haloacetic Acids (552) __ Other:_________ ;________ r_________ pH ___________ __ Other Pesticides (SMI8/6630) __ UCMR List 1 1 RADIOCHEMICAL ANALYSIS _MtBE Only (524) __ Radon __ Other _____ _______________ •. ' J ' - INORGANIC ANALYSIS REQUESTED - Lab#: i I __ Color __ Acidity t^^’Aluminum __ Potassium __ Turbidity __ Alkalinity .--''Antimony ^■■Selenium __ pH __ Bromide jiA Arsenic ^'Silver __ Conductivity __ Bromate/Chlorate/Chlorite ■'-'"^Barium __ Sodium __ Corrosivity (temp: .’C) __ Chloride AA'Beryllium ^'-Thallium _ BOD (5 day) __ Cyanide _ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride j^Cadmium iiA^inc _ Soluble BOD (5 day) ,_ Hardness, Total as CaCOs __ Calcium, as CaCOs "CLP’ __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ __ Dissolved Oxygen __ Nitrogen, Nitrate as N __ Metals/CN jAL'Chromium, Total __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Volatiles __ Cfiromium, Hexavalent __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N Ji'c5obalt __ Semi-violatiles _ Solids, Percent (%) __ Pesticides/PCB’s __ Oil and Grease jsA Copper __ Solids, Settleable __ Phenol I'dron __ Solids, Suspended TCLP __ Phosphorus Total as P _ifLead __ Solids, Total __ Phosphorus, Ortho as P _TCLP-Metals __ Magnesium __ Solids, Total Dissolved __ Sulfates __ TCLP-Pesticides _ui'Manganese __ Solids, Total Volatile __ Surfactants __ TCLP-Herbicides ^f/lercurv I A^'^Cther: A _ fCLP-Volatiles _ UV254 _-:'Molybdenum _ TCLP-BNA’s _r-'Knckel

NYC-WTC_000074830