Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document ■ as® ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM II HHH WESTCHESTER COUNTY LABORATORIES AND nFSEARCH Mt 2DanaRoad, Valhalla. New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set:____________________________________________ ____ _________________ ________________ )_________ Form A-70 (rev, 1/96) .... Sample Type (circle one); r M ft?

1.1 Potable 3. Non-Potable Treated Bottle #’s::____r 7.'. yfr:' __ 2. Non-Potable 4, Other. Chain of Custody?, yes no Time/Date Collected: .cm: ^pJ Comments:„d J.;J . ®7: - .. Ch Collected Bv: b’ ' -^• 7-~ C i Agency Code: PWS #:: Source ID? Type Descriptor: Collected From: Bill to: Location's/lndividual’s Name___ : Y-ir 43: Narne/Conipany Street g I V- f U ■- <7 £' . ■ r Citv/St/Zip J'D hr. Ur. Citv/SVZip l8MlllleiBsB/BWiiW:|gi8777g Phone#: Fax #: Collection Point i .; rCA?CH7Bi?Z ~ Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: _______ Lab#:_____ (circle tests) (circle tests) 1. Heterotrophic Plate 1, Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ''T\ Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 1^7 Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihaiomethane Potential (510) 4. Phthalates (606/8060) - 4, Fecal Coliform (ail samples) 5. Microextractabies (504) 5. Orqanochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. PCB's (Arochlors) (608/8080) 6. Macroscopic 71; Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7A»: "8? PCB as Decachlorobiphenyi (608A) 8. Other Pesticides (SM-18/6630) 8. Other: Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) 10. Glycols in Water Refrigerated?yes no Carbamate Pesticides (531) 11. Acid Extractabies (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractabies (625/8270) yes no 13, Diquat (549) ’ (^^GC/MS Unknown Scan Chionnated?/ 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) 15. Haloacetic Acids (552) IS. Purleable Aromatics (DEF) rree Chicnne Res: mg/L 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: mg/L 17. Petroleurm'Hydrocarbon Scan (310-13) 17. F^CB's (Arochlors) (DEF)

.....J INORGANIC ANALYSES REQUESTED - Lab#: (ClfCie tests) ........ MNii 1. Coior 2. Tiiibidity 20. Acidity 21. Alkalinity, as CaCOa 39. Aluminum 740; Antimony . 59, Potassium 60. Selenium -■7'8®^ 3 ph 22. Bromide ‘41. Arsenic 61. Silver ■I. 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 5. Corrosivity (ferrtp: .“C) 24. Chloride I 43. Beryllium 6. BOD (6 day) 25. Cyanide 44. Boron 7 Soliibie BOD (5 day) 26. Fluoride 45. Cadmium 6, Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs Chfi 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N ( 47). Calcium, Ca*^ 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 11, Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium. Hexavalent 12. Total Organic HaMes 13. Solids, Percent (%) 31. Nitrogen, Total Kjeldahl as N 32. Oil and Grease 'SO. Cobalt '’Si. Copper .70. Disk Deliverables ■ 14. Solids. Settleable 33. Phenol ^52. Iron

ilBS;. 18 Solids Total Volatile 79. Oihe, : ' . :===- :•== 3/. Surtactams 38. UV2S4 56. Mercury les:

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