Chain of custody record, Westchester County Lab, Nov 2001

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM "

HI Utestehestertounty ^^me/Date Set:_________ WESTCHESTER COUNTY LABORATORIES AND RESEARCH * ' 2 Dana Road, Valhalla, New York 10595 (914)593-5575 1^

NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Sample Type (circle one): / 1.' Potable 3. Non-Potable Treated Bottle #’s:. P /lA v-V 2. Non-Potable 4. Other_____________ Chain of Custody? yes no Time/Date Collected:___________________ Comments: Collected Bv: ( M k) .Agency Code;. PWS #;________ Source ID; Type Descriptor: Collected From: Bill to: Location's/lndividual’s Name. - I 6let bU'vik Name/Company Street__________________ Street__________ City/St/Zip______________ City/SVZip Identification of Source Phone#;________ _Fax #;. Collection Point F - I CA, CH, Bl? 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) 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 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 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. PCS as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) ; (Other:___________________ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) . - 10. Pesticides (525) 10. Glycols in Water Refrigerated? .yes. no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12^ase Neutral Extractables (625/8270) Chlorinated?: • yes no 13. Diquat (549) is.^C/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. ■ 'z?-' .'i/- INORGANIC ANALYSES REQUESTED?, Lab#:. (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 4. Conductivity 5. Corrosivity (temp; 6. BOD (5 day) 7. Soluble BOD (5 day). '22. Bromide ■■■23. Bramate/Chlorate/Chlorite .“C) 24. Chloride 25. Cyanide 26. Fluoride 41. Arsenic 42. Barium 43. Beryllium 44. Boron 45. Cadmium 61. Silver 62. Sodium 63. Thallium 64. Vanadium 65. Zinc A

I P- 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium,-as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen. Ammonia as N 47. Calcium, 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 I . ,. Solids, Settleable 33. Phenol 52. Iron TCLP '^i5. Solids, Suspended 34. Phosphorus, Total as P 53. Lead 71. TCLP-Metals 16. Solids, Total 35. 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. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

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