Chain of custody form, Westchester County Labs, undated

NYC 9/11 Public Portal Document

III ENVIRONMENTAL SERVICES SAMPLE SUBMISSOE FORM WESTCHESTER COUNTY IAN0R/ OHIES AND ngs : ARCH 2 Dana Road, Valhalla, New York 10595 Iestchester (ounty 914) 593-5575 NYS-ELAP No. 101 Time/Date Set: Form A-70 (rev. 1/96) Sample Type (circle one): 074 K- 2 //1,7&*,16/ ttApr,7600g — PVSAP1Y .1 Potable ) 3. Non-Potable Treated Bottle #‘s: ___ _____________

2. Non-Potable 1 Other Chain of Custody?yes Time/Dale Collected: 906) 7 ■ Comments: ■■

Collected By:' ' ‘ f * •......... ___ Agency Code:___ PWS il: Source ID: Type Descriptor:

Collected From Bill to ’ Location’s/ndividual s Name_ (reli Name/Company Street ■ tAle L f - Street—to City/St/Zip . ■ ig__ _ Poku City/StZip. _ ‘Identification of Source___________ _ Phone*:_ _ ___ ________ Collection Point___ (0 _16) I CA, CH. Bl? Check#:. . .............. Amount?. MMMM N6G ‘ tstr orisj ANALYi S “ORGANIC POTABLE ANALYSES ' G -■ eNlC NGNUOABi L.S. it: ANAI YSI S Labt—O I Labwo (circle tests) (chde lests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ■ 2.y Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2 Coliform P/A (public supplies) (3/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Colform MPN (priv well, raw, stp) i 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507; 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic l 7.) Pesticides/PCB screen (508) 7 Herbicides (SM-18/6640; 8151) 7API 1 (109, Herbi Pesticciiddeses (525) (515) .00 10. Glycols in Water 8 PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 3. Other Refrigerated?_____ yes_____ no 11. Carbamate Pesticides (531) “9. Petroleum Hydrocarbon Scan (310-13)

11. Acid Extractables (625/8270) " ! 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) - Chlorinated'’: yes no T 3. Diquat (549) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res: _mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res:____ __ mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

_PH _ N *entri ANA'.r.'-c.s HH guTsh 1 .. (circle tests)—-WVV-==============!V54? ■ - t/ - (yA( D 1. Color. 20. Acidity #* ) 399. Aluminum 59. Potassium : 2. Turbidity .-21. Alkalinity, as CaCO? i 40. Antimony — Va— 60. Selenium 3 st PH Conductivity 22. Bromide 23. Bromate/Chlorate/Chionte 41. Arsenic 42. Barium 61. Silver 62. Sodium ’ ■ 5 6 Corrosivity (temp:______ °C) BOD (5 day) 24.Chlondet 25. Cyanide- 43.’Beryllium 44. Boron 63. Thallium 64. Vanadium :

7 Soluble BOD (5 day) 8 Carbonaceous BOD (5 day) 26. Fluoride 27. Hardness, Total as CaCOa e 45. Cadmium 46. Calcium, as CaCOa 65. Zinc____ ______ CLP 9 Chemical Oxygen Demand 10 Dissolved Oxygen 11. Total Organic Carbon 29. Nitrogen,en, NiNittriratete asasNao 28. Nitrogen, Ammonia as N

30.Nitrog N" 47. Calcium, Ca* 48. Chromium, Total 49. Chromium, Hexavalent Volatiles Ar 67.68.Semi-volatiles 66. Metals/CN

Cobalt 12. total Organic Halides 13 Solids, Percent (%) 011 and Grease 32.83 Phenol . 31. N.trogen, Total Kjeldahl as N "e 50, 51. Copper 52 Iron 69. Pesticides/PCB’s 70. Disk Deliverables TCLPsmos 34. Phosphorus. Total as P. 53.Lead ' 4. Solas, Settleable 715TCLP-Metals -16. Solids, Total 5. Solids, Suspended 35.Phosphorus, Ortho as R. 54. Magnesium . 136 Sulfates . 55. Manganese 72.TCLP-Pesticides 73.TOLP-Herbicides 18. Solids. Total Volatile ‘ 17. Solids, Total Dissolved

119. Other essT Ps 37 Surfactants 56.Mercurv ~-38.UV254_msn 57. Molybdenum 74.TOLP-Volatiles s ItMNNA’ 58. Nickel n NYC-WTC_000026925