Chain of Custody Record, Sample AE06457, March 2002

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ,‘Y/--'■‘ --i-'/ i« ACCo, 3 B' steT US B-/ WESTCHESTER COUNTY LABORATORIES AND RESEARCH s y0 a 2 Dana Road, Valhalla, New York 10595 I’-'-I (914)231-1620 Fax(914)231-1772 '7’ -. NYg-feLAPNo. 101Q8 g Time/Date Set: FormA-70(reY.l0/pi)-^S

2. Non Potable 4. Other Chain of Custody?ggg5^s----- No

Tline/Date Collected: Comments: _______ ______ _______________ g__ Coltected By:^» Agency Code: PWS#:, ^Sour^id;;^ .Type Descriptor Collected From: Bill 46: 1 Lccation's/lndivldual’s Name ■« Natne/Cpmpanyg g'M J Street _ ___________ _ Street _____ Cltv/St/ZlD ivi g Identification of Source,__ _ Phone#: _____ _Fax#:_l s Collection Point I CA,CH, Bl? ^Check#g —-

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BACTERIOLOGICAL ANALYSIS i Lab#;___________ ORqInIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS _ Heterotrophic Plate Count gg.Trmalofnetiianes (524) g J (hemocilaly8is & all others) _ Collform P/A (Public supplies) __ Volatile Halocarbons (524) ■ __ Volatile Aromatics (524) i _ Coliform MPN (prlv well, raw, stp) g; g_1<^lTrlhalortja^ne Potential (510) ’■" __ Fecal Coliform (all samples) / g Midrbscoplc _g. Macroscopic __ Mlcroextractables (504) _ Pesticldes/PCB screen (508) _ Herbicides (^M18/663O,8151) - g.' I gg API ., PCB as Decachlordblphenyi (508A) _ Other Pesticides (SMI 8/6630) ' - ■is I fti’ yg. Other ______ __ Herbicides (515) Pesticides (525) _ Petroleum Hyelrocarbon Scan (310-13) ftafrigefated? ___ yes no _L.Cart>aniate Pesticides (531) ■ /;^-;_g.Add:Exttbotabfiee/ie26ffl270Xeg^/g;ggW j,|;Chlorln^^:? ___ yes 5; Free Chlorine Res;___ no .mg/L Glyphosate (547) g gLDIquat (549) g __Chlorination Disinfection Byproducts (551) . Base Neutral Exlractables (625/8270) ’ ‘ Vgc/MS Unknown Scan __ Phthalates (606MS> ■ a'■'fl g tWal Chlorine Res: _mg/L _Hal6ac6tlc Acids. (5525g' .; Otltac(ggMi20S^^ ifS sll _OlherPesticides(SM18/6030) ■ g v / g;; > _UCMRLisf1 ' .-'ggY -y -'. / RADIOCHEMICAL ANALYSIS _MtBEOnly.(524) y '1 ^pther --r-——, . 'gygg' \ 'INORGANIC ANALYSIS REQUESTED - tab#: WIliiOIOSf’ _Color _ Acidity : 2_ Aluminum '/■?-g __ Potas8lum: _g Turbidity

_ Conductivity _ Alkalinity ' __ Bromide y __ Bromate/Chlorate/Chlorite «/Antimony ^Arsenic; grg >/Barium Sodium •,: ?ssr: ■•il

■'I _ Corrosivity (temp:_____ ’C) _ Chloride

1 Beryllium / y ^. Thallium ' _gBOD(5day)g __ Cyanide _BoronJj _ Carbonaceous BOD -(5..day) __ Fubride; / __ Cadmium Ji Ojbie BOD (5day) __ Hardness, Total as CaCOa __ Calclum.as CaCOs saje

I _g -Chemical Oxygen Demand _ Nitrogen. Ammonia as N Calciurn, Ca'^' _ Dissolved Oxygen i^Chromluni, Total __Metals/CN ' __ Nitrogen, Nitrate as N __ Total Organic Carbon :_ Nitrogen, Nitrite as N Chromium, Hexavalent __ Vblatifes - TLL total Organic Halides _Semgviolatiles __ Nltrc^n,; Total Kjeldahl as N Cobalt;.:y; _Pes«ades«:B'B ^iM Percent (%) ' ggv-Solids, Settleable gj_ Sdli^, Suspended __ Solids, Total __ Oli and Grease _ Phenol g __ Phosphorus total as P _ Phosphorus,; Ortho as P ; iCbpper'.'-g? gg'g;g,yg;,' Iron'"'.^^'? Lead __ Magnesium ICLE _TCLP-Metals 1 __TCLP-Pestlcides gL_ /Sollite, Total Diswived _ Sulfates .^Manganese/ g^^li^, WVblatlle __TCLP-Herbicldesg _ Surfactants w Mercury/g/sg ggg- ,iY^TGLPA&i6tiie8;g;',r C^f?ther _ UV^ . gy y- Molybdenum r- ■ __TCLP-BNA’S gg:g.ig''' g,;::;g VNickel///;/ ;. ?;rg;g ..'■■a NYC-WTC_000075390