Chain of custody record, Sample AE06529, March 2002

NYC 9/11 Public Portal Document

4'

ixvcoin ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 3 .H ACOOj

J ' 2 Dana Road. Valhalla, New York’10595 ; (914)231-1620 Fax (914) 231-1772 ic7^ o

NYS-ELAP^No/IO W' 7^ I Form A-70 (rev.10/01)

Sample Type ic.ecne): 1. Potable 3. Non Potable Treated , Bottle #'s:A j ,3 3^/. .A J? .. .t, ; 2. Non Potable 4. Other Chain of Cus^o^y^ ^Ye<72_^' ? Tlme/DateCollected: Comments:_ _________ ;_________________________ Collected By: < >.■ «£ Agency Code: PWS #:Source ID:----------- Type Descriptor: ------- 7 Collected From: Bill to;

I? Clty/St/Zip________ ;____ _ ; Name/Company Street__________ L_ City«t/Zip;7_xJ,i^^ H ■1 71 Identification of Source Phone#: _________ fl Collection Point . .. . [ CA.CH. Bl? / Check#: Amount$„

I 7 _ , _____ L BACTERIOLOGICALANALYSIS 7Lablfe777^T'777777 7 /; -^77 7^r ' s ORGANIC POTABLE ANALYSIS ORGANIC NONPOTASLE/SOLID ANALYSIS _ Heterotrophic Plate Count _Trihalomethanes (524) 7« i>.Purgeable Halocarbons (624/8260) (hemodlalyste& all others) , ._^VolatlleHalocarbon8 (524) _ Collfdrm P/A (Piibitesuppnes) - ‘ fT;:. Cplifofm MRN wen, fe*t stp) '_ Volatile Aromatics (524) ' Z SSnlXyioXif __ Fecal Coliform (all samples) ‘ __ Microscopic __ Macroscopic _ Total Trihalomethane Potential (510) ? X- Mlcroextractables (504) _Pestlcides/PCB screen (505) z2SK«Mr^ PCB as Decachlorobiphenyl (508A) other Pesticides (SM18/5630) , t ‘W

s ;L^'API777y.77.<7;T77 »Y<pthfflg77/n7T\7"777.. _ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13) , __ Pesticides (525) 7' 7771 'Refrigerat^tTll-,'^ no" 7_Cartfemate Pesticides (531) _ Add Extraclables (625/8270) Chlorinated:?__ .yes. E Free Chlorine Res:_____^n^ ^Glyphosate (547) - Diqi^ (549) _ Base Neutral Extractables (625/6270) -- Ai^/MS Unknown Scan __ Chiorination Disinfection Byproducts (551) . _ Phthalates (606MS) ’ a Total Chlorine Res: _ mg/L _ Haloac6tlc Acids (552) v.i ■otherZZLZZZiSZiiL^iLZ^B^ _Other Pesticides (SMI 8/6630) ■ 777^ I RADI9CHEMm,AN>^ Only (524) jgTZI:' 1 __ Radon -r7'’7 7 YL'bthet«7SL.^,LL^uLLXX^^ ZZZI INORGANIC ANALYSIS REQUESTED - Lab#: . 1 __ Color j^Wuminum '■ jB*^mmony< 7'17"- / ' .^,ip,8Slenium pH _ Bromide txArsenlc ;• 7 jd;«h«r<-7-<<7 __ Conductivity __ Corrosivity (temp BOD (5 day) i — Carbonaceous BOD (5 day) “C) _L. Bromate/Chlorate/Chlorite 7/^4,>8arium'''7 _ Chloride 7 "■ _ Cyanide />^eryillum _ Boron .77x3^ 7'7_i:Sodlum^'<'/7. ^jt-JRiallium 7 7i. \fehdd a _ Fluoride . __ Cadmium ; X^iubte ; (Sday) ; : ’ __ Hardness, Total aS CaCOs __ Calcium, as CdCba ; L— Chemical Oxygen Demand __ Dissolved Oxygen _ total Organic Carbon __ Nitrogen, Ammonia as N _ Nitrogen, Nitrate as N _ Nitrogen, Nitrite as N __ Calcium, Cd^ 77 _4tf©hromlum, Total _ Chromium, Hexavalent ^MetalsWSN' _\folatlles Semi-vioiatiles /K __ Total Organic Halides — NIttogert, Total Kjeldahl as N xwa8balt77.7v-'-) 4 L^ Pesticld^PCffs i __ Solids, Percent (%) __ Oil and Grease \_?Sollds. Settleable __Solids, Suspended __ Solids, Ibtel A __ Phenol __ Phosphorus Total as P _ Phosphorus, Ortho as P j«e&pper Ztfiron __ M^neslum 1. ’ _TCLP-Metals I _ Solids, Total Dissolved ^Solids, Total Vblatlle -^*ther. ___ Sulfates __ Surfactants _ UV254 _i.J4dfiganese _dteA5®rcury _.j-Motybd8nLim . -'cY ■ ■ _TCLP-Pe8tlddes , _TCLP-Herbicldes. : __ TCLP-Voiatlles _TCLP-BNAS? I NYC-WTC_000075401