Chain of custody record, Sample AE06529, March 2002

NYC 9/11 Public Portal Document

•I ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

I WESTCHESTER COUNTY LABORATORiES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 NYS-EIAP No. 10108 Time/Date Set: Form A-70 (rev. 10/01)

SAmple.iype:(drde.one):' , vi.PiRbi^^;>(Y3. Non Potable Trssfed 2. Non Potable 4. Other iW Bottla#'8: Chain of Custody?___ Yes___ No I Time/Date Collected; _________ 3 Comments; Collected By: Agency Code: PW8 #;_________L. Source ID:Type Descriptor Collected From: Bill to: Ldc^Hipn’i^ndivIdu^ 's Name __ _ Name/Company Street ________ . Street CIty/St/Zip _________ _ City/SVZip ______

1 Identification of Source _____ Phone#: ; Collection Point _________ I CA,CH, BI? „ Check#: > Amount$_

BACTERIOLOGICAL ANALYSIS Lab#: ■I Lab#: organic potable analysis ORGANIC NONPOTABLE/ SOLID ANALYSIS __ Heterotrophic Plate Count __T«halomethane8 (524) __ Purgeable Halocarbons (624/8260) (herrtodlalyslsaall others) ■■

_ Cellform P/A (Pubiic-suppites) - _Volatt!e Halocarbons(524) _ Purgesbte Aromatics (624/8260) _ _Z Coliform MPN(priv well, raw, 8tp) Volatile Aromatics (524) /V? _ Acroleins Acrylonitrile (8260) Ki:

I fecal Cfoliforrn (all eatripleS) _ Microscopic ■ __ Total Trihalomethane Potential (510) __ Microextractables (604) __ Pestlcldes/PCB screen (508) _ Organochlorlne Pesticides (608/8081) PCB's (Arochlors) (608/8081) ; ilL Herbicides (SM18/^G815()S /" 1 _ Macroscopic I __ PCs as Decachiorobiphenyl (508A) Other Pesticides (SM18/6630) -__APi'-'-- _ Herbicides (515) PetfoleUfn Hydroc&rbon Scan (310-t3) . a r Refrigerated? yes_ _ no _ Pesticides (525) __ Carbamate Pesticides (531) -- Glycols In Water - Acid Extractables (625/8270) I g Chlorinated:? yes__ _no _Glyphosate (547) _Diquat (549) Neutral Extractables (625/8270) _?rl3wMS Unknown Scan Y I Free Chlorine Res:______ mg/L •fetal Chlorine Res: ______ _mg/L _ Chlorination Disinfection Byproducts (551) __Haloac8tic Adds (552) ■ XiiPhthaiates (608MS) Other:_________________________ I II -pH.-^_____^'v'.-. _ Other Pesticides (SM18/6630) _UCMRList1 I RADIOCHEMICAL ANALYSIS __MtBE Only (524) s'- i__Radon'i/ >•r-- £_ 0th8r'..;__i______£JL^ s s: v"'- INORGANIC ANALYSIS REQUESTED - Lab#: _ .■'_^:CoIor. _ Turbidity , " *- ^Addity __ Alkalinity J^^minum __1vitimony ' __ Potassium ’ I _ pH _ Bromide .isArsenic __Conductivity _ Corrosivity (temp:__°C) __ BOD (5 day) __Carbonaceous BOD (6 day) _ ^luble BOD (5 day) __ Bromate/Chlorate/Chlorite __ Chloride _ Cyanide ;_ Fluoride __ Hardness, Total as CaCOa Jfc^rium _iewry|lium _ Boron __ Cadmium _^Calcium, as CaCda ' ; _L Sodium jiffhalliurn _^^adlum , 1 __ Chemical Oxygen Demand _ Nitrogen, Ammonia as N _'C^clum, Ca** : ' x,^(^romlum. Total _Metals/CN _ Dissolved Oxygen _ Nitrogen, Nitrate as N _ Volatlles • <■ __Total Organic Carbon __ Nitrogen, Nitrite as N _ Chromium, Hexavalent _ Semi-violatiles _ Total Organic Halides __ Nitrogen, Total Kjeldahl as N .ia^alt^/ __ Solids) Percent (%) _ Oil and Grease .^Copper ^Pestlddasff^B’Sv _ Solids, Settleable _ Phenol _ Solids, Suspended _ Solids, Total __ Phosphorus Total as P __ Phosphorus, Ortho as P _ Magnesium _TCLP-Metals _TCLP-Pesticides^ I _ Solids, Total Dissolved __ Sulfates j«s451angan8se __ Solids, Total Volatile _TCLP-Herbiddes _ Surfactants jiflQiercury ■- _ TCLP-Voiatlles. »**^her * _ UV254 jssfMolybdaium ; / _TCLP-BNA’s ; i-riMickel

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