Chain of custody record, Westchester County Labs

NYC 9/11 Public Portal Document

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111 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Y ' WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Daria Road. Valhalla. New York10595 Utestehestef Court/ / .ZNYS-ELAP No. 10108 (914)593-5575 •Yir^Bhe/Pate Set: Y'f ' '■ A- Form A-70 (rev. 1/96) Sample Type (circle one): (^^Potable Z /3. Non-Potable Treated Bottle #’s:__^___^____________________ S 2; Npn-Potable'YY 4. Other Chain of Custody? ves no 'Tiiiie/Darte Colled:- ; -- /f- / - q / Comments: Cc^llected By: A/ £ Agency Code: ’ PWS Source ID: Type Descriptor; Collected Fronh: Z Bill to: 1 ocation’s/lndividual’s Name AZ T C Q£ f * Name/Company. Street_ Street________ cay/St/Zip'- \ City/Sl/Zip Identification of Source Phone#:, Fax#: Collection PoinV / ■ /Z I CA, CH. Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLEZSOLID ANALYSES ■/ :Lab#:__SlO:___-_.^^ Lab #: ' ■ . : -;(circletests) .; ; (circle tests) , ■ 1/ Heterotrophic Plate/; - : .’ i. Trihalomethanes(524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & ail. 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/'welk stp) 4. -. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) ,■ \ ■ 4. Fecai Cplifprm (all samples) . /. ■ 5. Microextractables (504) i , 5. Organochlorine Pesticides (608/8080) ■// 5..Microscopic .- ' ' Pesticides (507) 6. PCB's (Arochlors) (608/8080) ■ - /6; Macroscopic' Y- Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. PCBas Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) ^ Herbicides (515) ■ / -9. Petrojeufn Hydrocarbon Scan (310-13) / @ Pesticides (525) ’ 'S S S \10. Glycols in Water /Refrigerated? yes'. A ho 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) ' Y , . / 12. Base Neutral Extractables (625/8270) | ■ Chlonriated?; yes Y' no ■ 13. Diguat (549) ^^GC/MS Unknown Scan . 14. Chlorination Disinfectiori Byproducts (551 j iZ Purgeable Halocarbons (DEF) Free Chlorine Res' - ' ■ • / mq/L ■ 15. Haloacetic Acids (552) S ' > '15..'Purgeable Aromatics (DEF) S ’ S: Y.'^. '' ■ '’y’ ' i ' • 16. Other Pesticides (SM-18/6630) Y S 16’Feticides (D^) Total Chlorine Res: mq/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

pH. z7 z < / / = INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1.;'Color. " 20. Acidity 39. Aluminum Q SO.J’otassiu'in 2.<T u'rbidity 21; Alkalinity, as CaCOa Antimony “60. Seleniurri' 3. pH . 22. Bromide 41. Arsenic ^Silver 4. Conductivity . 23. Bromate/Chlorate/Chlorite ^4^ Barium Z62.’)Sodium 5.- Corrosivity (temp: '."C) - 24. Chloride {^3^ Beryllium { 63.frhallium 6. BOD (5 day) • ' 25. Cyanide ' 44. Boron \g^Vanadium .7. Soluble BOD (5 day) / 26. Fluoride 45. Cadmium .65.Ziric . Y .8. / Carbonaceous BOD (5 daiy) 27. Hardness, Total as CaCOa .. Calcium, as CaCOa ■ CLP S 9. . Chemical Oxygen Demand 28. Nitrogen, Ammonia aS N ' (^^^Calcium. Ca"’ 66.'Metals/CN. ;10. Dissolved Oxygen ; 29. Nitrogen, Nitrate as N ;; Y 48. Chromiurn, total / 67.'Volatiles ' 'Y1. totaiOrganic CarbonY// , / 30. Nitrogen,^Nitrite as N ; 49/Ohromium, Hexavalent ;// 68. Semi-volatiles ,; ' •. 12< total Organic Halides ; / 31. Nitrogen, Total Kjeldahl as N (^^ Cobalt Y Y . Y///. 69. Pesticides/PCB's Solids, Percent (%) 32. Oil and Grease .^Sj. Copper 7O.ii3isk Delivefables Y Solids. Settleable ' 33. Phenol ' </^5^lron TCLP Solids. Suspended Y Y; ; // 34, Phosphorus. Total as P Sgj_Lead /Y,/,,/ Y/^ 71. TCLP-Metals 16. Solids. Total 35. Phosphorus, Ortho as R Zw^^agnesium ■ ; 72. TCLP-Pesticides ; /17,;Solids.:;^talCiissplyed Y 36. Sulfates ; -..55? Manganese 73. TCLP-Herbicides iolids/T^A/^tiie/Z'; 37. Surfactants ' ' 5^ Mercury 74. TCLP-Volatiles Si >ther: ■Sa____ 'Y. -.T'> • '_■ '38.t.lV254 ' ■ - - . • QpMolybdenum .,58'.Nickel/ . ’ . 75. TCLP-BNA's

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