Chain of custody record, Sample AE06580, March 2002

NYC 9/11 Public Portal Document 1 t I ' V ACCo ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM t Y WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 ’ (914) 231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Time/Date Set: ( f A r. •s t Form A-70 (rev. 10/01) J Sample Type (circle one): - J ZTTyt ■ (1 .'Potable 3. Non Potable Treated Bottle #'s: _1 »*<•*•. 5 W 1-! 2. Non Potable . 4. Other Chain of Custody?___ Yes___ No , t J Time/Date Collected: 1 V- r- Comments; •.Xi: Collected By: L n z Agency Gode: PWS #:______ Source ID:t .Type Descriptor:., Collected From: Bill to: i' •r Location’s/lndividual’s Name Xi f ■' Name/Company I Street i' ! T if 1 * Street __ _____ * Clty/SUZip .A

. Identification of Source V X r ■tv City/St/Zip Phone#: Fax#: 1 s Collection Point _f__ u; ::Ys CA,CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#:_______ ________________ __ Heterotrophic Plate Count Lab#:

ORGANIC POTABLE ANALYSIS __ Trihalomethanes (524) ORGANIC NONPOTABLE/ SOLID ANALYSIS __ Purgeable Halocarbons (624/8260) I (hemodialysis & all others) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) Volatile Halocarbons (524). ■ —A/olatile Aromatics (524) ’ __ Purgeable Aromatics (624/8260) __ Acrolein & Acrylonitrile (8260) •a- __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) __ PCB’s (Arochlors) (608/8081) __ Macroscopic __ Pesticides/PCB’screen (508) _ Herbicides (SMI8/6630,8151) _ API __ PCB as Decachlorobiphenyl '(508A) Other Pesticides (SM18/6630) • __ Other:_____________________ __ Herbicides (515) _ Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) __ 'Glycols in Water ' , Refrigerated?yes ___ no __ Carbamate Pesticides (531)’ __ Acid Extractables (625/8270)' Chlorinated:?yes no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) ; __ Diquat (549) _:^GC/MS Unknown Scan ' ' Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) __ Phthalates (606MS) Total Chlorine Res:nng/L^ pH _x______ __ Haloacetic Acids (552) __ Other Pesticides (SM18/6630)' ' __ Other:' 1 I - 1 _UCMRList1 1 RADIOCHEMICAL ANALYSIS _ MtBE Only (524) __ Radon ’ __ Other____________________ (

INORGANIC ANALYSIS REQUESTED - Lab#: f I' 1: __ Color __ Acidity 2r1^luminum -_ "Potassium j. _ Turbidity __ Alkalinity ■^-'Antimony ‘ , ^'Selenium ■ . — pH __ Bromide YArsenic _i-Silver __ Conductivity ;<■ __ Bromate/Chlorate/Chlorite jX Barium 1 __ Sodium __ Corrosivity (temp: °C) __ Chloride * _^Beryllium jjL'Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium ■ It __ Carbonaceous BOD (5 day) -__ Fluoride ji^j'Cadrhium --•'Zinc __ Soluble BOD (5 day) ■__ Hardness, Total as CaCOs __ Calcium, as CaCOa "CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N ., __ Calcium, Ca+? __ Dissolved Oxygen c _ Metals/CN __ Nitrogen,. Nitrate as N j:::fChromium, Total .‘S ' __ Volatiles' __ Total Organic Carbon _ Nitrogen, Nitrite as N _ Chromium, Hexavalent ' __ Semi-violatiles __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Solids, Percent (%) __ Solids, Settleable __ Oil and Grease __ ' Phenol Cobalt ^-Copper zfron' __ Pesticides/PCB’s

TCLP 4 __ Solids, Suspended '__ Phosphorus'Total as P _;i-Cead __ Solids, Total _TCLP-Metals __ Phosphorus, Ortho as P __ Magnesium __ Solids, Total Dissolved __ TCLP-Pesticides Sulfates -'Manganese __ Solids, Total Volatile _iTCLP-Herbicides __ Surfactants _rrK4ercury __ 'Other: _'TCLP-Volatiles _ UV254 Molybdenum __ TCLP-BNA’s _ii-'Nickel 1 . t NYC-WTC_000075412