Chain of custody record, Sample AE06580, March 2002

NYC 9/11 Public Portal Document J I •a 1 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)231-1620 Fax (914) 231-1772 A Id Ml E sc « NYS-ELAP No. ,10108 Time/Date Set: t Form A-70 (rev.10/01) 'I Sample Type (circle one): Sy 14 l/potable 3. Non Potable Treated Bottle #'s: £_L_jL±i « < SY 2. Non Potable 4. Other - Chain of Custody? Yes___ No Time/Date Collected: Comments: Collected Bv: u. ‘I T T - Agency Code: PWS #:________ Source ID: Type Descriptor: I Collected From: Bill to; .) ’ Location’s/lndividual’s Name bJ "'41 ‘ Name/Company ■ 3 Street *'1 U) f- ? / Street 2 f City/St/Zip L - , . ■ City/SVZip ■ 3 Identification of Source Phone#: Fax#:1 Collection Point i k. I CA,CH, Bl? Check#: Amounts ■ 71 J.; BACTERIOLOGICAL ANALYSIS Lab#: '3. Lab#: ____________________ ___ __ Heterotrophic Plate Count (hemodialysis & all others) ORGANIC POTABLE ANALYSIS __Trihalomethanes (524) i ORGANIC NONPOTABLE/SOLID ANALYSIS __ Purgeable Halocarbons (624/8260) t I __ Coliform P/A (Public supplies) ^'■'(/olatile Halocarbons (524) __ Purgeable Aromatics (624/8260) ;• _ Coliform MPN (priv well, raw, stp) _^'\/olatile Aromatics (524) __ Acrolein & Acrylonitrile (8260) __ 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 (SM18/6630,8151) _ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SMI 8/6630) )• __ Other:_____________________ Refrigerated?yes no Herbicides (515) __ Pesticides (525) _ .’Carbamate Pesticides (531) __ Petroleum Hydrocarbon Scan (310-13) ' __ Glycols in Water / , ‘i/' 4 __ Acid Extractables (625/8270) Chlorinated:?.yes___ no __ Glyphosate (547) __ Base Neutral Extractables (625/8270) __ Diquat (549) _r: 'GC/MS Unknown Scan 'iJi Free Chlorine Res: Total Chlorine Res:mg/L mg/L __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) __ Phthalates (606MSj __ Other:________________ ___________ I pH -------------

RADIOCHEMICAL ANALYSIS _Other Pesticides (SMI8/6630) _UCMRList1 _MtBE Only (524) 'I- __ Radon __ Other____________________

INORGANIC ANALYSIS REQUESTED - Lab#. 1 i/i'/ __ Color __ Turbidity _ pH __ Conductivity Corrosivity (temp:. .°C) __ Acidity __ Alkalinity __ Bromide 2_ Bromate/Chlorate/Chlorite __ Chloride z Aluminum _2'^ntimony _-Arsenic YBarium ^■'Beryllium __ Potassium i/Selenium ..^■'Silver ■ _ ('Sodium >' •'Thallium - J ' ■>

__ BOD (5 day) __ Cyanide , '’ __ Boron __ Vanadium __ Carbonaceous BOD (5 day) __ Fluoride _:L'Cadmium --Zinc __ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOs ~CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca'"^ __ Dissolved Oxygen __ Nitrogen, Nitrate as N i_ Metals/CN 2L(^Chromium, Total __ Total Organic Carbon 1_ Volatiles • __ Nitrogen, Nitrite as N __ Chromium, Hexavalent __ Total Organic Halides !__Semi-violatiles __ Nitrogen, Total Kjeldahl as N I _/Cobalt '__ Solids, Percent (%) __ Oil and Grease < Pesticides/PCB's -'Copper __ Solids, Settleable __ Phenol ..zlron __ Solids, Suspended TCLP __ Phosphorus Total as P __,Lead __ Solids, Total _TCLP-Metals __ Phosphorus, Ortho as P __Magnesium __ Solids, Total Dissolved _L Sulfates __ TCLP-Pesticides .Manganese __ ,Solids, Total Volatile _ Surfactants __ TCLP-Herbicides __ Mercury Other: JL, _ UV254 I _ TCLP-Volatiles ^Molybdenum _ TCLP-BNA's _j2’Nickel >

NYC-WTC_000075413