Chain of Custody Record, Sample AE06333, March 2002

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION .7yr:: FORM I ^15 i

WESTCHESTER COUNTY LABORATORIES ANO RESEARCH ... = ’ 2 Dana Road. Valhalla, New York 10595 /(914)^t-W0 Fax^14)1»tr1^2^: ® "

8 Time/DataSet: tsS^ Sample Type (circle one): "t

. 1,potable 3. Non Potable Treated

Ih;< l^ble '' ' _

> Chain of Custody?___ Yes

PWS#:Source ID: ___Type Descriptor No -

' ■'• '- no. '■ ■ • :■ : /:®/< S'- ®'S= Collected Fromr I[ L Bill to: , ' . ; ®, ’ iW: Location’s/lndlvldual’s Name _ Name/Company____________________ t ...... ?......... , i, • ’■' ' '?;Street: -.- ■'-

i _ Clty/St/Zlp______ /.t , .. , " . .t

r IdentlflcatlonofSource Phone#: '• Kai#' ' - '/i ~ = .. ■ .... , if®'. ’ t"t'"■’■ s' t Collection Point_____________ j - rCAcirBiTZZHZZTcheSdT^^ fe' I^CTERIOLOGICAL ANALYSIS ORGANIC POTABLE ZwfcS®^ T”ZOZLr I (hemodlal)«la & allothers) _ Coliform P/A (Public supplies) ? _Triha!om8thanes (524) ^. Volatile Halocarbons i(^) ®

I;t® ^ Coliform MPN (prlv well, raw, stp) _ Facal Coilform (all samples) .^Microscopic , ®||ilacrb8<^fe® _ Volatile Aromatics (524) _Tota!TrihalomethanePotentlat(510) = __ MIcroextractables (504) _ Pesticldes/PCB screen (508) /

I?;'■■■•>■ JLTAPI ®_ PCB asDecachloroblph8nyI{508A)" other,___________ _Herbicides (515) y;; ■.< “

ll' Refrigerated?------ yes_ _ Pesticides (525) _ Carbamate Pesticides (531) C.hlorinated:? ,.„„yes_ _ Glyphosate (547) Fr^WrineRes:____ ia£J®B|HES^|^S^2a«fea£2£±:SS®SsS3!:^ _ Chlorination Dlsthfectlon Byproducts (551) . s/;: _Haloacetlc Adds (552) . TotalChlorineRes: r’W; _Oth0rPe8tIcides(SM 18/6630) L ■-M iPH J---------------- __UCMRUst1 '^^ADioCHliwCAL ANALYSIS Cr.T»Tff _Mt8eOnly(S24) , . , l'>8 SiiiESisSfelfe^ B INORGANIC ANALYSIS REQUESTED - Lab#: ZZxZZIIIZZSZZZZZEEZZZZ^

It = ' z«. III# __ Conductivity

_ BOO (5 day). _ Carbonaceous BOD (5 «tey) ___Bromate/Chlorate/Chtorite

__ CytetWe _ Fluoride :V.

_ Chernies^ Oxygen Demand __Dl8so{VQdOxygen =:f:>-/,■ ® __ Total Organic Carbon _ Nitrogen, ArarBonIa as N

..........Nitrite __ Nitrogen, .................................................................. as N ' .......... zSS:S« •• ' Mm I /^ “ “ WQigahlp - ■ _ SolWs, Percent (%) _ Solids, Settieable _ Solids, Suspended Halides ; / .. Nltrogen. Tofol l^eldahl .^jMb^i _ Oil and Grease _ Phenol WlWaW^N

_ Phosphorus Total as P as N < _ Copper _ircn „ Lead .Yi/ ■'■W'

/ ® SoHdsyfetaP ® _ Phosphorus, Ortho as P _ Magnesium _Sollds, Total Dissolved ■■■■- ' ® —'Sulfetes';\./’::'®;® ■■® i^iftfe^^Brtase':®'®; 1=4- .4®=. Sollds.;TfotaiVblatlle ■ / .‘4,®>. Surfactants ' \®d '.X’

y ® ®UV254

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