Chain of Custody Record, Sample AE06457, March 2002

NYC 9/11 Public Portal Document

- xsi'ACcoji. ENVIRONMENTAL SERVICES SAMPLE SUBMISSiON FORM

1vcom WESTCHESTERCOUN-TY LABORATORIES ANDRESEARCH u . ’ 2Dana Road, Valhalla, New York 10595J d'”’ (914) 231-1^0 Fax (914)231-1772 j, , ,NYS-lt^.,N^^l0l0SYW TIme/Date Set ■’87 Form A-70 (reVT0/O1^-,^j

(drde one): ;'- '"Z'--Z'-7 potable ' ' 3. Non Potable Treated Bottle #’s: j ZNon Potabie 4. Other Chain of Custody? __ Yes___ No Time/Date Collected:______-y -Comments: Agency Code: PWS#:Source ID: _____ .-I^Jbs^Ftorr-a^i^/ Collected From; Bill to: PLdc^’s/m<fivteuar-sHam&t,i.X£LL£^ Street_______________ Stl^___ City/St/ZIp____________ dty/SVZIp _ 1 Identification of Source Collection Point . PhohiB#:_ ) CA,CH, BI? _________ Fax#:_______

_ Check#: ______ Amount, s BACTERIOLOGICAL ANALYSIS Lab#< Lab#:_____________________ _ Heterotrophic Plafe'Count (hemodialysis & all others) ORGANIC POTABLE ANALYSIS _Trihalom8thanes(524) __ Volatile Halocarbons (524) < ORGANIC NONPOTABLE/SOLID ANALYSIS _.PUTgeableHalocarbons (624/8260) 4 _ Coliform P/A' (Public supplies) ' __Coliform MPN (priv well, raw. stp) _ Volatile Aromatics (524)' __ Fecal Coliform (all samples) _ Total Trihalomethane Potential (510) ’ Organochlorlne Pesticides (608/8081) ' _ Microscopic ' Microextractables (504) _' pCB'8 (Arochlors) (608/8081) __ Macroscopic . API _ Other______________ X Pestldtdes«»CB screen (508) _ PCB as Oecachlordbiphenyl (508A) _ Herbicides (515) _ Pesticides (525) <> _ Herbicides (SM18/6630.8151) ' __ Other Pesticides-(SM18/6630)

z I Refrigerated? __ yes___ no _Carbamate Pesticides (531) _ Add Extractables (625/8270) Chlorinated:? yea__ .no __Glyphosate (547) _ Base Neutral Extractables (625/8270) . ■i? Free Chlorine Res:_______ mg/L _Dlquat (549) _ Chlorination Disinfection Byproducts (551) .iX' GC/MS Unknown Scan Phthalates (606MS) 1 1 Total Chlorine Res: mg/L ^^ Haldadetlc Acids (552) _Other Pesticides (SMI 8/6630) pH - --------------- ------------------ _iUGMRLIst1

4 I1 RADIOCHEMICAL ANALYSIS __MtBE Only (524) 7-,'Y' , _Radon : _ Other X--- INOI^ANIC ANAl^iS REQOESTEC __ Color YLab#: . ..... .. ....... __ Addity '■'■-ZYAIiailnIty'Z?''?- j/Alumlnum .^Antimony __ Potassium ^'Selenium I 1_ Stbrha^Chlorate/Chloiite ^Barium . __ Sodium I (2- Corrosivity (temp:°C) '

Carbonaceous BOD (5 day) __ Chloride _2Ci^nlde __ Fluoride Beryllium _ Boron __ Cadmium ,'- i->'■ ^Thallium I _ Soluble BOD (5 day) __ Hardness, Total as CaCOa Calclutn, as Cat^j; J.5 _ ChemicalOxygenDemand „ Nitrogen, Ammonia as N __ Calcium, Ca*^, , Dissolved Oxygen ^Metals/CN; > __ Nitrogen, Nitrate as N Chromium, Total • _ Volatiles _ Total Organic Carbon _ Nitrogen, Nitrite as N _ Chfdhilum, Hexavalent ^ Ttjtel Organic Halides _Semi-vlblatije8: __ Nitrogen, Total Kjeldahl as N ;,/Cpbalt _ Pesticldes/PCB's __ Solids, Percent {%) / __ Oil and Grease jCopper ’< _^^<fe,Setfle^lei __ Phenol Jtiron' -• __ Solids, Suspended __ Phosphorus Total as P Z/Lead _TCLP-Metals ^/^lids,-total _ Phosphorus, Ortho as P __ Magnesium __TCLP-Pe8tidides / So8ds, ■total Dissolved __ Sulfates .^^^/IWanganese - Solids, -total Vblatlie ^Mercury _TCLP-Herblcides > ;_ Surfactante _TCLP-\tolatiles <_ UV254 ^Molybdenum '_^-rCLPSNA8-/.' .^Nickel

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