Chain of custody record, Westchester County Department of Labs &

NYC 9/11 Public Portal Document

1: ' ' ' ' '". ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH )• . 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108...^ Time/Date Set: Form /V-70 (rBV.10/01)

Sample Type (circle one): ^^otable 3. Non Potable Treated Bottle 2. Non Potable 4. Other________ ______ _ Chain of Custody? Yes No •I'

3 TlmeflOate Collected: ___5nZZZ:^_Z__ZIZ5Z^ Comments: Collected By: AgenJyCode: PWS #: :Source ID:: Type Descriptor: ' Collected From: Bill to: Location's/individuai's Name Name/Company . Street_ City/St/Zip_____________ Identification of Source Street _______ Clty/St/Zip _____ Phone#: _____ '' ■ I Collason Point CA.CH, Bl? _ v Amoi^nt$ SI S'

BACTERIOLOGICAL ANALYSIS Lab#: 3 I ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS ___ Heterotrophic Plate Count __ Trihalomethanes (524) _ Purgeable Halocarbons (624/8260) g,: - (hemodialysis & alt others) _ Coilform P/A (Public supplies) _A Volatile Halocarbons (524) _ Volatile Aromatics (524) _ Purgeable Aromatirs (624/8260) __ Acrolein & Acrylonitrile (8260) s _ Coliform MPN (priv well, raw, stp) ■’

_ Fecal Coliform (all samples) _ Total Trihalomethane Potential (510) Organochlorine^Pesticides (608/8081) Microscopic __ Microextractables (504) .^.. PCB’s (Arochlors) (606tel) ,, S- Macroscopic __ Pesticides/PCB screen (508) Herbicides (SM18/6630,8151) k' API __ PCB as Decachlorobiphenyl (508A) _ Other PesUcld^ (SM;10(M30) ; ‘J _Herbiddes (515) __ Petroleum Hydrocarbon S<ao‘ (31&-13); _ Other: Refrigerated? yes no _ Pesticides (525) __ Carbamate Pesticides (531) _ Glycols In water . _ Acid Extractables (625/8270) I Ch1oTlnated:7 yes no _ Glyphosate (547)--------------------- ---- — _±fiaseNeutralFxtractabtes(625/827O)-- __ Diquat (549) GC/MS Unknown Scan / Free Chlorine Res:. _______ mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS) . ; *: • *-• T Total Chlorine Res: mo/L _Haloacetic Adds (552) V' Omer:______Ll_._________X_- pH __ _______ _ Other Pestiddes (SMI 8/8630) _UCMRList1 RADIOCHEMICAL ANALYSIS _MtBE Only (524) ■ _Radon Other _______ _______

INORGANIC ANALYSIS REQUESTED - Lab#: _ Color _ Asidity Aluminum _ Potassium _ Turbidity __ Alkalinity Y Antimony Selenium _ pH __ Bromide .^Arsenic Silver _ Conductivity __ Bromate/Chlorate/Chlorite j/Barium _ Sodium _ Corrosivity (temp:. .’C) _ Chloride Beryllium 2 Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium -iZanc _ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs "eLE" ” __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 __Dissolved Oxygen __ Nitrogen, Nitrate as N __Metals/CN JsfChromium, Total _Volatiies __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent _ Total Organic Halides _ Semi-violatiles _ Nitrogen, Total Kjeldahl as N V Cobalt _ Solids, Percent (%) _ Pesticides/PCB's __ Oil and Grease _Z. Copper _ Solids, Settleable __ Phenol _i^lron __ Solids, Suspended __ Phosphorus Total as P ■ZLead ISLE _ Solid?, Total _TCLP-Metals __ Phosphorus, Ortho as P __ Magnesium _TCLP-Pesticides _ Solids, Total Dissolved __ Sulfates JL Manganese _ Solids, Total Volatile _TCLP-Herbicides __ Surfactants Mercury V' Other: ________ _TCLP-Volatile8 _ UV254 _j> Mdybdenum _TCLP-BNA’s _tNickel

NYC-WTC_000075000