Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document ill ■■■ s 111 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESf ARCH 2 Dana Road. Valhalla, New York 10595^ Ujess:hesti0fOxjnt¥ '■ NYS-ELAP No. 10108 (914)593-5575 Time/Date Set; Form A-70 (rev. 1/96) , Sample Type (circle one): 4*PotaW?B^ 3. Non-Potable Treated

2. Non-Potable 4. Other_____________ ___ : Chain of Custody?: yes no Time/Date Collected:.,. U/7 Comments:_____ ; Collected By: 0. SecTTV________ Agency Code:: _ PWS #;_____ ___ _ Source ID: Type Descriptor; collected From; , p Bill to; Location’s/lndividual’s Name_7_L7=_7L_L___ ' Name/Company: street____ _ Street___________ City/SVZip__JwlBllAi^^ City/St/Zip_______ : Identification of Source____________________________ ___ 1 _ Phone#:________ : Fax #: Collection Point } .Y- I F* ■ rcB~CK~BI? Check#: Amount$:

I BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#;______________ ___ Lab #;: (circle tests) (circle SesSs) 1, Heterotrophic Plate 1. Trihalomethanes (524) 1, Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) , Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) Pesticides (507) 5. Organochlorine Pesticides (608/8080) 6. PCB's (Arochlors) (608/'8080.) ■ 6. Macroscopic 7. AP; Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (SOSA) 7. Herbicides (SM-18/6640; 8151) 8. Other Pesticides (SM-18/6630) J7l 8. Other;______ 9.. Herbicides (515) @ Pesticides (525) 9. Petroleum, Hydrocarbon Scan (310-13) B Refrigerated? vesi ■■IB no 11. Carbamate Pesticides (531) I !?:SSStXS:,^ ill 12. Glyphosate (547) 1.2.62 Chlorinated?;yeSj no 13, Diquat (549) 6^! 14, Chlorination Disinfection Byproducts (551) Ta P« Free Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) ,6. Pes,ic,d,s (DEF) Total Chlorine Res: ma/L - 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

£W illlB _____ _________________ ____________________ _____ ____ ®__________ " 8/ 7" '■ -v 'V /■, f i________________ INORGANIC ANALYSES REQUESTED >Lab#:„..... It J.. . SSI

1. Color 20. Acidity 39,^Aluminum h. 59,-Potassium 2. Turbidity 21, Alkalinity, as CaCOs L^O.^ntimony 60. Selenium 3. pH 22, Bromide . 4'1. Arsenic Silver 4. Conductivity , 23,.Bromate/Chlorate/Ch!orite 42. Barium (iB^’Sodium 5. Corrosivity (temp; .OC) 24-; Chloride C43B3eryllium 763. Thallium 6. BOD (5 day) 25/cyanide 44. Boron L&4ZVanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65, Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CLP 28. Nitrogen, Ammonia as N ^^Calcium, Ca’" 9. Chemical Oxygen Demand 10. Dissolved Oxygen 11. Total Organic Carbon IIS'S" 68, S. , , . ? T«. n.-,.,-.- H.-H- 31 M, 01 as (sj T«=. Kjeldahl 35 N C50„.Cobai1 69. Pesticides/PCB’s tl

uiiSdisX;:" ■ 15. Solids. Suspended 34. Phosphorus, Total as P Sl^Copper: £2.'lron 70. Disk Deliverables ICLP / !. i Kdi.P-NiCial i Io • i ct.'J 16. Solids, Total 35, Phosphorus, Ortho as P TMagnesium^ /;■. iC! P Pei.ti.'icLv.: 17. Solids, Total Dissolved 36. Sulfates 7 TManganese: ■i .18 Solids. Total Volatile 37. Surfactants . .^Mercury 19.1 Other: 7-0 j*T j_______ 38. LiV254 L ( /CKel

NYC-WTC_000070688