Chain of custody record, Sample AE06584, March 2002

NYC 9/11 Public Portal Document

a. ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ACCn-^ ■1 ter WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 f NYS-ELAPNO, 10108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type (circle one): 1, Potable & Ite Potable Treated Bottlers: 2. Non Potable < Otte,,., Chain of Custody?_________ if' Time/Date Collected: _____ OBBWaiirtK ; A ........ Collected Bv:.., , ...... . Agency Code: FWSft______ ^urcelD: Type Descriptor: Collected From: Location’s/individuai’s Name Name/Company Street »«__ City/St/Zip....... ..................... . City/StZZip Identification of Source _____ Phone#: Fa* Collection Point CA,CH, Bi? Check# Amounts, '4 BACTERIOLOGICAL ANALYSIS Lab#: >1 Lab#:______________ _ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS 4 Heterotrophic PiateCount (hemodialysis & all others) _ Trihatomethanes _ Purgeable Halocarbons (624/8260) „ Coliform P/A (Public supplies) (524) _ Purgeable Aromatics (624/8260) __ Coliform MPN (priv well, raw, stp) ^-Volatiie Aromatics (524) (8260) __ Fecal Coiiform (all samples) __ Total Trihalomethane Potential (610) _ Organochlorine Pestloides (608/8081) __ Microscopic ^MlaandnKMiKm _ PCB's (Arochlors) (608/8081) __ Macroscopic _ Pesticides/PCB screen (508) ,, Herbicides (SM18/6630,8151) __ PCB as Decachlorobiphenyl (508A) _ Other Pesticides (SMI8/6630) _ other __ Herbicides (515) _ Petroleum Hydrocarbon Scan (310-13) _ Pesticides (525) Refrigerated? __ Carbamate Pesticides m _ Add Extractables (625/8270) Chlorinated:? „ Glyphosate (547) __ Base Neutral Extractables (625/8270) _Diquat (549) __ GC/MS Unknown Scan Free Chlorine Res:. -____ Chlorination Disinfection Byproducts __ Phthalates (606MS) Total ChtorineRes: ....... mg/L _Haloacetic Acids (552) Other........_____________________ Other Pesticides (SMI8/6630) __UCMRList1 RADIOCHEMICAL ANALYSIS „MtBE Only (524) —JWISB . - Other____ ___ _____

INORGANIC ANALYSIS REQUESTED « UBfc T _ Color — Aluminum __ Potassium _ Turbidity _ Alkalinity _ Antimony _ pH ___Bromide „Arsenic __ Silver Conductivity _ Bromate/Ghiorate/Chlorite Barium _ Sodium _ Corrosivity (temp:,------ »C) __ Chloride ___ Beryllium __ Thallium _ BOD (5 day) __ Cyanide __ Boron Carbonaceous BOD ^ da^ __ Fluoride __ Cadmium _ Vanadium jL Zinc 4 __ Soluble BOD (5 day) _ Hardness, Total as CaCOa _ Calcium, as CaCOs _ Chemical Oxygen Demand Nitrogen. Ammonia as N _ Calcium, Ca« _ Dissolved Oxygen _ Nitrogen, Nitrate as N 2„Chromium, Total __ Total Organic Gabon _ Nitrogen, Nitrite as N __ Chromium, Hexavalent _ Total Organic Halides _Semi-vloiatiles __ Nitrogen, Total Kjeldahl as N Solids, Percent (%) Oil and Grease _Pesticld0g/PCB's __CoHBW _ Solids, SeWeable _ Phenol „ Solids, Suspended __ Phosphorus Total as P me Solids, Total _TCLP-Metals __ Phosphorus, Ortho as P _ Magnesium _ Sulfetes __TCLP-Pestlcides _Manganese Solids, Total Volatile _„TCLP-Heri)icide8 „ Other:______________ __ TCLP-Volatiles _„TCLP-BNAs ^Nickel ?

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