Chain of Custody Record, Westchester County Lab, Mar 2002

NYC 9/11 Public Portal Document ■y'f-yi

. ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESI^CH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 i MYS-ELAPNo. 10108 J Tlme/DateSet; form A-70 (rev.10/01) firSample Type (circle one): y\: ' :: If fi. Rotable 31 Non Potable Treated Bottle #-8: 'S‘ 2. Noh Potable 4. Other Chain of Custody? __Yte __ No I TIme/DateCoBected: Comments:. .

I Collected Agency Code: PWS#: Source ID: _____Type Descriptor /Collected From: Bin to: .Uocation’s/lndtvldual’s Name _ Name/Company 'Street ' ' '.Street I City/SVZlp___ Tr ■

I'l^tiflcation of Sourt^ Phone#: •J :^e<aion|ctt,^^___^^ |CA,CH,B1?, Chectdfe Amounts I / l^t^t^bGlCAL ANAtYSiS

ORGANICPOTABLE ANALYSIS __Trihalomethanes (524) / ^.PurgeableHaloqabona (824/820))' ? I . (hemodialysis &^F^bltesuwlM) alt others) Volatile Halocarbons (524) __ Volatile Aromatics (524) Purgeabte Aromatlcs (824/8260) SCoHfoim MRN OW w^. raw, stp) ■gJ^^,.CqBf^'' (aB8att^^ ’■'. ■ _ Total Trlhalomeftane Potential (510) _ Organochlorine Pesticides (608/8081) - /'■ _h4lotP®#actab!esX5O4) __ Pestlddes/PCB screen (508) - ' __ PCB as Decachlorobiphenyl; (508A) Otti9rp0GU(^c(6^ (SM^$w630)

|1SI^W1?;M- yes no , .S _HQrbi<^’(515)

_i_CarbaniatePe8ticldes{531) a^^^oagg _ Glyphosate (M7) ‘ _.Diquat(549} Ghiortni^n Disinfection Bj^EMuct _HaloaC^c Aclds W) 8wc M——- fh^ •■' . _ Other Pesticides (SMl^fa) _^UCMRLM1, i IWIOCHBNWCALANALYSIS f J*!I

s ”^G^ICANALYSIS -? MZ~Z/3 • :* -Aluminum - ’ t. ^Po^um 4;^“ ?yy.y-i'i^', : 1$??' i SyiSi/B H-’ ^ CorrosivltY' (tempi:- , .; Chloride - , 2 Beryllium • , -

:S’'6heroiiB3HI8Hffi8. ^■'. HarSs. Tbtatas CaCO3 Nttrcaefi,Ammoniaa8N ; Nifirogen.-NltrateasN _Nitrogen,Nitrite as N _S£rwas CaCO3

; ' _ Nltro^n. Total iqeldahl as N <^Cobalt / _:.OBandGrea8o Jechromlum. Total ^■ Chromium. Hexavg^t

MCopper f ?"

‘:7 • • -t ^SteajJ W

4 i H ^_j-ph^M ‘ y:. ................... " y.^r•'.■Miran'- -.y'. -' i_ Pho^horus Total as P- , f^.M^0ad,;f, < , H^OfthoasP ;.-.,-,-.e«-—»--T-7---- ■ :^xy4’y ■ed __TCLP-H^ldde8 •1 gw^ ^MoMxtenum ■’ . _TCLP-VolatlliBS \_TClPeN«8 '

'f fit®: .afeyi’C-;. Siissi;>SS^y NYC-WTC_000074903