Chain of Custody Record, Sample AE06406, March 2002

NYC 9/11 Public Portal Document ■■ .- -Y,: ‘I/’ 6 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH . 2 Dana Road, AfofoaHa, New Vbrk 16595 M ■ X (914) 231-1620 Fax (914) ai-ITTO iJi?' Yi i Tlme/Date Set: NYS-ELAPNo. 10108' ■ FormA-70(rav.10/01)-’\

r Sample Type (circle one); ^9’0‘abte 2. Non Potable • 3. Non Potable Treated 4. Other </ ^Z3Z-33^7 JzfekX Bottis #’s: . Chain' of Cust^y?,..,^^x.No' ( <Tltne/Dafe;Coliegtad:,. Comments: " 7./ _ ■' Collected By.. Agency Code: .. ' PWs1lif______B;'^WlE>:-. Cteaaiptt^^^ CollectedFrom: Bill to:

I ^^tocatlan’s/lndlvidual's Name Street NameA^mtipany "bX ; Street _____ '"'■tW-XXB' X

£ City/StZZip _______ ’ Identification of Source ___________ 6^tap.i£_ -OH __-2^i*L£Li3

i /75»Bectlon'Polht._;^__^^

BACTERIOLOGICAL ANALYSIS Lab#: _________ wSiSWwiiSWW teANICNn«OOTAR,H organic POTABLE ANALYSIS _14efetort^phic Plate Count (hemodialysis & all others) __Trihalomethane8 (524) _ Coliform P/A (Public supplies) __ Volatile Halocartaons.(524) Coliform MPN (priv well. raw. stp) _ Volatile Aromatics (524) . i ■ _ Total TrIhalomethane Potential (510)

“’"nteBiM ;__;;FeGal 0?O)rm (alLsar^^^ S> __ Mlcroscopic " __Microextractabies(504) t. _ Pesticidee/PCB sBeri^) 7 __ PCS W Decachlorqbiphenyi (508A) JS'CBWflK'f -Other; _ _________________ __ Herbicides (515) / , im Hydrocarbon Scart (310-13) /J 5’- _ Pesticides (525) n Refrigerated? yes _ no __Carbamate P0Sttcldes (531) ®CKra!8L!SSP2&;«;’w I'JF^phW^ Ra8:_£__,__._..'fo 'Z.6blc«Hatlon Disinfeffitloh Byproducts (551) I" Total ChlorineR8s:____ mg/L _Hajoac8tteA^^(5^;-., _Othor Pestidde^(SM18/6630) Other '■fi

PH__------------ ._UCMRlJ8t 1 ! _^BgOnly(5i4|‘Y/ I .... ........................ INORGANIC ANALYSIS REQUESTED- Lab#. ;? . ' ;2X" : -.color r.l-A/ / _A»W ,• tL a':^Alo^lnW.« CT } t _ Turbidity/ -2 pH ■5iOpdnd^^ J _LAIitallnllyB'; ‘ ' ...... _Bi^de'- ■■_^;B»biha^lorateA5hlprito' : J<Antimony .j^Barium — X.-i-, ' X^B' pl g B zasaasw.*-* zss£.™..oc«:o3 =x:.M ■.■..•/r^ i _ Chemieal Oxygen Demand - __ Nitr^en. Ammdnlaas N '■■ ■ h /U;2fe8^9xygerrxx- _ Total Organic Carbon __,Ntab^ Nitrate as n ; .^, :^hrorrtum. TbtalC X -; ; Jl-Wsfe^MMb'seNB :CcB«»ixR^bfehi^ . WwwBxiijFfl U/TbtetOtWfcWes _. Nitrogen,Total Kjeidahlas N .^Cobalt 9^ 3 Z_:SOB<P^(%)^^^ _ . x^-SrtiS&as^fe-. -Y IC^^ ' •■3‘v'- ■u; f ' ’ - _ Phenol. Xi’ r _Sp«ds,SuSpended _ Sollds, Totei _.PhOs^ro8Total asP LJi PiW&s. Ortho as P jcLsad. 'W ' ■ •/

I x_ ^Solids, Tbta! Dissolved _Sulfate8 Manganese Y.icMaWx , »• ~TCLP-HerSicidesS; i’ jjiMo^bdenum (^^NfctelY ■'1 _TCLP.Volatfles _TCLP^.'\ I ■5

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