Chain of Custody Record, Sample AE06423, March 2002

NYC 9/11 Public Portal Document

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s ■ y ;.. .Y?-. . -/ ■ ” ■ ?2 Dana Road, Valhalla, New Yorl< 10595 " ■■■^.(g<4)^231-1620;Faj{(914).i31-irr2Y"''EE< Y."K'Y^ '.•V' i Sample Typ® (circle one): Bottle#’s: P / ^fPotebl®’ 3 Non Potable Treated ; •i’ ^^ItorfRotebie 4. Other - ' _E_________ Chain of Custody? Yes J_ No Comments:_________ - ; / , ¥' ; {tolled^ By-' Idf b * A^cy Codie/Wbb PWS #:Sou.de ID: _ Collected From:

s , Locatlon’s/lndIvtdual’s Name___ e streeblbZbBibOB^ ______ ^^^StfZIp ________ _ ____________ Citv/StZZiP Identification of Source _______ v F^one#:__.biJSSbS^ •Vr Collection Point |^CA.CH.B1? I' BACTERIOLOGICAL ANALYSIS ORGANIC POTABlS^^^ Lab#: - ;Y/YYYai3YifiYsag»»» s'Li ■1^'-——— 6 iT (hemodialysis Heterotrophic Plate Count I & all others) _Trihalom8thane8 (524) _ Purgeafale Halocarbons (624/8260) ■ -E -j. 3?: X; Coliform P/A (Public supplies) _ Volatile Halocarbons (524) _ Volatile Aromatics (524) I _ Coliform MPN (priv well, raw, stp) _ Fecal Coliform (all samples) _ Total Trihalomethane Potential (5lb)

II _^Mlcrd8coplc __ MIcroextractables (504) YY Macroscopic _ Pesticldes/PCB screen (508) 'iYAPi'< _ PCB as Dscachlorobiphenyl (508A) _Other. __________________ _ Herbicides (515) _ Petroleum Hydrocarbon ; _ Pesticides (525) _ Glycols in Waler Y )^^erated? __ yes___ no __Carbamate Pesticides (531), _ Add Extractables (625/t ... fe Chlorinated:? x__ yes no _ Glyphosate (547) Sy

_ Diquat (549) fc FreeChlorine Res:mg/L _ Chlorination Disinfection Byproducts (55t) YY^Rhti^^ YY . ...... TotalChlorine Res: _____ mg/L _HaloaceticAdds (552) Otaefc_xiTY^^

Ift' pH.............. < yradiochemical analysis _Other Pesticides (SM18/6830) _UCMR ListT Only (524) ' ' C'-"'' Y TE'-EE;I ZZZZZZZZ3S2EY' I jgOther_________ F I' INORGANIC ANALYSIS REQUESTED- Lab#: ^Coldrjvt _Addlty 7 Aluminum fS Y-Y'Turbidlty ■;i4pH:-Y^- _ Conductivity : __ Alkaltiity E _ Bromide Bromate/Chlorate/Chlorite _ Antimony _Arsenlc _Bariiim' ■>£ rsOMsOWwl _ Corro81vity (temp:____ °C) E-,: BOD (5 day) __ Chloride B^lBurn’ < ySE, ■ __ Cyanide __ Boron _ Carbonaceous BOD (5 day) _Fluoride __Cadmlum U Soluble BOD (5 day) _ Hardness, Total as CaCOa Calcium, as CaCOs Mr : j Chemical Oxygen Demand Nitrogen, Ammonia as N _ Calcium, Ca*’ ■■, V-•

Dissolved Oxygen E; Tdtal Organid Carbon _ Nitrogen, Nitrate as N _hliti^en. Nitrite as N _Chromlum, Total , __ Chromlum,Hexavalent' s _ Total Organic Halides __ Nitrogen, Total iqeldahl as N _iCobalt

I ' Solids, Percent (%) ZySolids, Settleable ^dSollds, Suspended X-:8plid8vTbtal 7 __ Oil and Grease _ Phenol ; _ Phosphorus Total as P __ Phosphorus, Ortho as ,P ^CopfterE<U";;rY:-;;-Ei

; Iron' Y.■■'EYf-''.-’' Magri^lunYEExE'E'Vy •W- II I rTaSJSS.':' jil Solld8,Tbtaf Dissolved __ Sulfates __ Manganese ;y_ Solids, Total Volatile __ Surfactants _Mercury" 'O Other. 'r _ UV254 _ Molybdenum

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