Chain of custody record, Sample AE06580, March 2002

NYC 9/11 Public Portal Document

•-f ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Jfestchester WESTCHESTER COUNTY LABORATORIES AND RESEARCH ‘ 2 Dana Road, Valhalla, New York 10595 (914) 231-1620 Fax (914) 231-1772 1 TS ' NYS-ELAPNo. 10108 Time/Date Set: (. Form A-70 (rev.lO/Oi) ■"■'Y

Sample Type (circle one): /I. Potable ■ 3. Non Potable Treated Bottle #’s: /. ■ * Z - -6 .L.z 2. Non Potable 4. Other Chain of Custody? Yes No, Tirhe/Date Collected: _______ - .J ■ 62 Comments: Collected By: “L. Urc/Ag Agency Code: PWS #:________ J Source ID: L Type Descriptor:

Collected From: Bill to: Location's/lndividual's Name Y C' Name/Company Street i r <1 Lo I .■•-f - Street________ _ I c- !■ 6 * i f' City/St/Zip ■T S City/St/Zip / Identification of Source Phone'#:_______ Fax#: Collection Point / ■a \ r-A Y I Z CA,CH, Bl? Check#: Amounts .1.. BACTERIOLOGICAL ANALYSIS ,Lab#: Lab#:__________________ __ ORGANIC POTABLE Analysis ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260) ■'I __ Coliform P/A (Public supplies) _^Volatile Halocarbons (524) __ PurgeableAromatics (624/8260) _^\Zolatile Aromatics (524) __ Acrolein & Acrylonitrile (8260)

r __ 'Coliform MPN (priv well, raw, stp) . __ 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 (SMI 8/6630,8151)

I .. API __ PCB as Decachlorobiphehyl (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:? Free Chlorine Res: Total Chlorine Res: yes no - mg/L . mg/L __ Glyphosate (547) __ Diquat (549) __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) __ Base Neutral Extractables (625/8270) 4_xGC/MS Unknown Scan __ Phthalates (606MS) _ Other:_______ ____________________ I __ Other Pesticides (SM18/6630) pH ___________ ■6'.' _UCMR List 1 RADIOCHEMICAL ANALYSIS __ Radon _MtBEOnly (524) ‘i I: __ Other____________________ I S' ' INORGANIC ANALYSIS REQUESTED*- Lab#: __ Color __ Acidity j/Aluminum _ Potassium __ Turbidity __ Alkalinity Antimony j^Selenium _ pH __ Bromide zArsenic Ji/Silver __ Conductivity __ Bromate/Chlorate/Chlorite ■ zBarium _ Sodidm __ Corrosivity (temp:. °C) __ Chloride' .^Beryllium Z±L'’Thallium _ BOD (5 day) __ Cyanide __ Boron __ Vanadium _ Carbonaceous BOD (5 day) __ Fluoride _^Cadmium Zinc' _ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaCOa -S'’ "CLP __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*2 * __ Dissolved Oxygen ^X&hromium, Total _Metals/CN' __ Nitrogen, Nitrate as N^^ __ Total Organic Carbon __ Total Organic Halides __ Nitrogen, Nitrite as N __ Nitrogen, Total Kjeldahl as N __ Chromium, Hexavalent ^"Cobalt )_ Volatiles ■*. '__Semi-violatiles ' I' __ Solids, Percent (%) __ Pesticides/PCB’s "_ Oil and Grease ■xCbpper __ Solids, Settleable __ Phenol ^Iron TCLP __ Solids, Suspended __ Phosphorus Total as P _/Lead _ Solids, Total _TCLP-Metals __ Phosphorus, Ortho as P __ Magnesium __ , Solids, Total Dissolved I__ . TCLP-Pesticides __ Sulfates ^Manganese __ Solids, Total Volatile ._TCLP-Herbicides __ Surfactants ..-'Mercury ^-r'-'Other: ___________ t_TCLP-Volatiles _ UV254 Molybdenum _ TCLP-BNA's _ii'Nickel NYC-WTC_000075414