Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM lestole SU 1 WESTCHESTER COUNTY LABORATORIES AND RESEARCH 1. gO\(ni - M( Valhalla, 2 Dana Road,914) New York 10595 593-5575 00 NYS-ELAP No. 10108 (‘Date Set: Form A-70 (rev. 1/96)

Sample 5 Type (circle one): 1/1—.706,770128/CrOet PFe9cG,998 . P0,Q-/6 o // 973%, $ 1. Potable 3. Non Potable Treated Bottle #‘s:J_______

27Non Potable 4. Other J_ _ Chain of Custody?___ yes no Time/Date Collected:... 4_ ___ ______________ Corents. Collected By:... /NAAN___ Agency Code: PWS #: _ _ Source ID:___ _ ___ Type Descriptor:.... Collected From: / Bill to; ■1 Location’slndividuar’s Name A} C Z) E I" / £ A Szo c/46 Name/Company_

Sti ‘ NasT LL. Qrv _ __ Stet___ City/StZip VALHIA/A ................ ... City/St/Zip_ __ Identification of Source___ ____ _____ _ _ _.............. _........ _ Phone#: _........ _..... Fax#: . Collection Point _ _AzLAfr___ CA,CH, Bl? _ Check#: Amounts___

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ■■ ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#: __ _______________ Lab#: J _* (circle tests) (circle tests) $* Tr I 1. Heterotrophic'Plate .1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) a Vol Hiic Arojaal" ( 4 .. , : i * Atarylonin ( * i 3. Coliform MPN (privwell, raw, stp) 4. loti lboilosdharBopterlta tolte -4 Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Macroscopic Microscopic 16, Pesticides (507) !■. Mirooltad" b . (001 _ 5,Organochlorine Pesticides (608/8081) 11. ■ (Arocliot i (68, it) S ' , 18. PCB PCB oscreen Pesticasides/Decachl (508) robiphenyl (508A) — 7. Methoprene (616) 8. Herbicides (EPA1978/8151) 9. Herbicides (515) 9. Pesticides (SM18/6630) 60 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) fisiociutuul ___ yes _ liv 11. Carbamate Pesticides (531) .Glvcos Chlorinated:? __ yes___ no 12. Glyphosate (547) 12. Acid Extractables (625/8270) . 13. Diquat (549) 13, Base Neutral Extractables (625/8270) Free Chlorine Rest mg/L 14. Chlorination Disinfection Byproducts (551) (14.GC/MS Semivolatile Unknown Scan 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res:. _ mg/L 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:______ _ __________ __________ 18. Other

INORGANIC ANALYSIS REQUESTED - Lab#: _ (circle tests) IAYgal APTYttHYt 1 1. Color 0 20. Acidity 21. Alkalinity, as CaCOs 39. Aluminum (40) Antimony 59. Potassium 60. Selenium I 2. Turbidity -3.DH 22. Bromide 23. Bromate/Chlorate/Chlorite 41. Arsenic 42. Barium 61. Silver 62. Sodium i . ■ 1 4. Conductivity 5. Corrosivity (temp:______ °C) 24. Chloride (43 Beryllium 63 Thallium " ‘ ’ 1 25. Cyanide 44. Boron C.64. Vanadium 6. BOD (5 day) 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10. Dissolved Oxygen 27. Hardness, Total as CaCO3 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N cium,um,CaTotal . 47.48. CalChromi 46. Calcium, as CaCOs ”A 0e4 CLP 66. Metals/CN 67. Volatiles 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 3 * vio ril.

011 an Grease_ AD.C obalt 11. Total Organic Carbon

I 12. Total Organic Halides 13. Solids, Percent (%) 32,33.Phenole al Nitio ) tal Kjs n .. t —51.Copper 52.Iron--- 01! .■ ticda MCI ■ a . i n ;. ! olmnabl . g Solids, Settleable ver 53 Lead TCLP 16, Solids, Total 1 7, Solids. Total Dis olved — .1 Mepn ptl .i !

fates en 36.37. SulSurfactants 3 Mlcrlils Qi* I 154Maqnesium 55 Manganese 1 IGPM iat, i. Iu l ■ 1 '< tko.

18. Solids, Total VolA atile. nh" 119. Other 33 UV2s. ---56. Mercury re — (57 Molybdenum n 4 it !■ ! I mrlo i i Cl P V tit ‘ ft । P I 'NA'. 58 Nickel -

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