Chain of custody record, Westchester County Department of Labs

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UI UMchetter County >- ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM \WESTCHESTER COUNTY LABORATORIES AND RESEARCH

• -*' 2 Dana Road, Valhalla. New’.Y^ 10595 (914)593-5575 II NYS-ELAP No' 10108 Time/Date’Set: '____________ ____________________________________ __ _________ Form A-70 (rev. 1/96) Sample Typo (circle one); ' ■ , v* ' I "T O U Potable 3. Non-Potable Traated Bottle #^s:'' Y -

2, Non-Potable 'g'A. Other^;______ __ _________ _____________ Chain of Custody? _____ yes no Time/Date Collected: ■•I'.AJ*- A < , - > Comments:

Collected By: -Agency Code: ■ pWS : ^.Source ID:. .Type Descriptor: p-' ■■ 'BHIto; ; .;V Location’s/in’dividual’s Name' -__ - ' ■. Name/Comoanv' ' :_____ ;_____ Street ' '• -^4 lY .'lY .b " , ;■ . ; ■' , Street < ______ City/St/ZipL21____<i^^ • ' J -■ ; ■ Cit^SVZiD ■ ’ • Identification of Spurce^i^^'-^ "Y' _ • • Phone#:,' ■ -i-Y''-- ■ ■ -iFax#:. Collection Point J - "■ . - I CA; CH, Bl? ’ • ' - Check#:, Amounts.

BACTERIOLOGICALANALYSESVY. ., ORGANIC NONPOTjABLE/SOLID ANALYSES Lab#:j<5^^&^lQ^y^^C (circle... 1. Heterotrophic PI^e*'. br 4 T^*Trihal?im6thane^/524)^^£; i''■’Trihalomethanes (524)^?; I• Purgeable Halocarbons (624/8,260^. Count (hemodialysisl all bthors)': fcx:^(:^afil^Halocarfx5i^524^ . . 2. Purgeabie Aromatics.(624/8260) /. 2. Coliform (YA;’(^blic;s^pliM)^^ft Volatile.Aromatics (524)"'’■ V<. ' 3. Acrolein & Acrylonitrile (6i24) ,/... l-ri. 3. Coliform MPN (priv,well,'i^w,,stp)' 4? TotalTrihalorn'ethane Potential“(5i0) , ■ 4.- Phthalates (606/8060) ’ 4. Fecal Coliform'(all samples)'' ' 5.' Micrbextractables (504)'• ' , 5. Organochlorine'Pesticides (608/8080) 6.'; Pesticides (507) V'J. ' . -

51 5. Microscopic . 6. PCB’s (Arochlors) (608/8080) (^;;;Pesticides/pCB screen (508)^^;' . 7. Herbicides (SM-18/6640; 8151) 6. Macroscopic ■ YZ 7.AP! . ■ 8.""PCB as Decachlordbiphenyl (SOSA)' . . 8. Other Pesticides (SM-18/6630) ^y 8. Other:- ■ a^ Herbicides (515) ; 9. Petroleum Hydrocarbon Scan (310-13) ; 4'.- ^Pesticides (525) ' . - . ' 10. Glycols in Water Refrigerated? yes'- ;-Y. i'no' ' '1? 11. Carbamate Pesticides (531) , . 11. Acid Ex1ractables (625/8270) * ’■ / 12. Glyphosate (547)'" i" -’5* Base Neutral Extractables (625/8270) Chlorinated?: yes no : 13. Diquat (549) .•>. -"'j,;.,'■ ■ • GC/MS Unknown Scan 14. Chlorination Disinfection'Byproducts (551) T’4. 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)

.J ■ . . -4* : ' ______ b, A - INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) ■ (HWo ! i 1. Color 20. Acidity 39, Aluiriinum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40, Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp; .’C) 24. Chloride 43. Beryflftim 63. Thallium t.- 6. BOD (5 day) ■25. Cyanide 44. Boron 64. Vanadium. 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. ■CalqjdrflTas CaCOs CLP 9. Chemical Oxygon Demand • 28. Nitrogen, Ammonia as N 47;:^a'|^m, Ca*^ 66. Metals/CN 10. Dissolved Oxygen ' 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68, Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51.Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron ICLE 15. Solids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. Solids, Total 3^. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other;____________ ___ 38..1IV254 57. Molybdenum 75. TCLP-BNA’s "'li 58. Nickel ■