Chain of custody record, Sample AE06449, March 2002

NYC 9/11 Public Portal Document

& ; ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ^com WESTCHESTER COUNTY LABORATORIES ANO RESEARCH |f':3 * 2 Dana Road, Valhalla, New York 10595 ' . ' ^/iUPi .......... . (914)231-1620 Fax (914) 231-1772......................... \ f Time/Date Set:

/ttoHspW Tnyp© (drdeone):^ ^Potable 2. Non Potable 3. Non Potable Treated 4. other Chain of Custody? ___ Yes _ No' ZEKZZ g[^t|/Da^Goftected: /■ ■ ' Comments:

S' CollectedBy: Pm __ Agency Code: Source ID:.. ' - . Type Descriptor:_____ Collected From: Bill to: ty?. jLopatton's/Ind Name _ Nam0/Company;_2_- B iCtty/St/Zip ________ .'f ti^st/zip,_L_4y Identification of Source Collection Point _________ E^- __- ChGck#:______ Amount$_J___

i W-'/' WT' ?. BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS __Trihalomethanes (524) _i_ Coliform P/A /Public Applies) _ Volatile Halocarbons (524) Cdilferm .MPN (priv well, raw, stp) __ Volatile Aromatics (524) I-' Fet^Cdltfbrm (all samples) __ Microscopic _ .Total Trihalomethane Potential (510) < _ Microextractables (504) __ Macroscopic __ PeSflcldes/PCB screen (508)

I API _O9»r:------------------------------ Refrigerated?___ yes no __ PCB aS Decachlorobiphenyl (508A) < ; _ Herbicides (515) __ Pesticides (525) __ Carbamate Pesticides (531)

I Chlorinated:?------yes _ no Free Chlorine Res: Total Chlorine Res: mo/L mp/L __ Glyphosate (547) Xblcidat|-(549)X--'^T-Y--.:YYY-^^X< XChlorination Disinfection Byproducte (551) HaloeceflcAclds __ Other Pesticides (SMI8/6630) __ Phthalates(606MS) ' LxZZZlIxSSSS-'* 1 ; >'

F' pH ................... ......................... Pl _ MtBE Only (524) | RADIOCHEMICAL ANALYSIS

I —Radon

I; INORGANIC ANALYSIS REQUESTED - Lab#: _ IJj-CoIoT tiirbfdlty __ 'Addlty ^Alkalinity ' _ Aluminum ' /-iiAhtlrnwy'S- hOIM pH ' X Conductivity _ Bromide __ Bromate/Chlorate/Chlorlte __ Arsenic , __ Barium 6 __ Corrosivity (temp:‘’C) ' __ Chlortde __ Beryllium ;

I __ BOD (5 day) 6artxjnaeeous BOD (5 day) LX>Sl«ubIe BQD (5day) _ Cyanide __ Fluoride Hardness. Total as CaCOa ,:_T:Bordrl;Y® CsSimfuM./-.*t..-, ■-=:<ri Calcium, as CaCOa ’’ '

‘Msi! __ Chemical Oxygen Demand _ Nitrogen, Ammonia as N __Caiclum, Ca*2 . , 'u SS3

i __ Dissolved Oxygen _ Total Organic Carbon __ Nitrogen, Nitrate as N _ Nitrogen, Nitrite as N X. Chromium,'Hexavalent * __TotalOrganlc Halides _ Nitrogen, Total Kjeldahl as N _ Solids, Percent (%) ; XWIi<$dtBeabl&/; _ OH and Grease Phenol;/?'/ I :X Su^iwded __ Solids. Total __ Phosphorus Total as P zS I XCSdll^’BJtiS Dissolved _ Phosphorus, Ortho as P Sulfas h __ Magnesium

-sar* ' ' I X SolId|S,:Tl3taLVblatlle

^SSS __ Surfactants —.Mercury - i X Other: Xd_X__ _ UV254 __Molybdenum • • __ Nfckoh'M’'/ ,,, , ... . . ........

NYC-WTC_000075365