Chain of custody form, Westchester County Dept of Labs

NYC 9/11 Public Portal Document

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ENVIRON'MENtAbSERVICEXsXMl^E^B^ *' WESfCHESfER ’COUNTY LABORATORIES AND RESEARCH "*• ' ' " 2 Dana Soad. Valhalla, New Yor'k 10595 , ' ^ .UlKtchettar County - ’ NYS-ELAPNo 10108’ .‘^stim^Date Set; Form A-70 (revr'I/gG)'^^;'' /sample Type (circle one): , PF&« w (^Potable - ’ 3. Non-Potable Treated . . Bottle #s: 74?r) rz L' Non/Potable A. Otherj J; .jL vCKain of Custd*dv?- - - -yes ■___ L_n’6 f ime/Date Collected: ; 7Ai7-o/ ;Cornments: -

Collected Bv: Agency Code: PWS _____ .Source ID:Type Descriptor:. ^Collected From: Bill to: ' • Location’s/lndividual’s Name MVC Name/Company. ■ .street, 'n 'Qgfve '■ Street_________ ‘3 ■City/St/Zip City/St/Zip ■ Identification of Source Phone#: Fax #■•_

Coliection Point, T)c- I I CA, CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES ■ Lab#:__:_______________ _________ Lab #:_________ _J__________ ■(circle tests) (circle tests) •1. Heterotrophic Plate -1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) ' Count (hemodialysis & all others) Volatile. Halocarbons (524) ■; 2. Purgeable Aromatics (624/8260)' . ■^2. Colitorm P/A (public supplies) Volatile Aromatics (524) , . 3.. Acrolein & Acrylonitrile (624) ;3.,Coiif6rrh MPN (priv we'll, raw, stp) 4, Total Trihalomethane^Potential.(5l6),, ■4.^ Phthalates (606)8060)^ $ 5. Microextractables (504)^ 5? Organochlorin'e'Pesticides (608/8080) ■ •4, Fecal Coliform (all samples) 6;1 ■PCB's lArochl^s) (608/8080)

I : 5. ’Microscopic '6i Macroscopic \ Pesticides (507) Pesticides/PGB screen (508) ,8. . PCB .as’PecachloroBiphenyl,,(‘508A), Herbicides (5’15)7 7? Herbicides (SM-'18/6640; 8151) 8? CMher;F?BSticides’(SMc18/6630) PetjoleUm Hyd'rocarbon Scan (310-13) tS/Other.ij Pesticides (525)Y .WtGlyi^rTW^er / ’ /^efrigejated? .yes no - -S. pTl. Carbamate.Pesticides (531)' " 11; Acid ^ractables’(625/8270) ’ •.1'2.'Glyphosate (547), ’ '* . . J^^js^^.Neutral.Ektr^t.abW^^ 13. Diquat (549)'. ■ ' ,, Q^.^iMSTOhknown Scan ' Chlorinated?:,- yes ’ - no h' '.'14. ChloririXtion Disinfection Byproducts (551)’ 14’purgeabl.e'.Halqcarbons/DEF), ■ Free Chlorine Res: mg/L f 1’5. Haloacetic Acids (552) 15.'.purge^le'Arpmatics'YD'EF)' \ 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/ / ■> ■

______ INORGANIC ANALYSES REQUESTED^^b#: ________ :(circle3ests) ■ ■ /’ , I... Color ’ . f^-A^dity ■ 39. Aluminum (5^ Potassium ,q ?2. Turbidity " 2L Alkalinity, as CaCOa ’ ^dpAntirnony ''60. Selenium' ^4’ \ 3. -pH. : Bromide 4T Arsenic^ '61'.,Silver" 4. Conductivity ;23'.Brpmate/Chlorate/Chlorite 42. Barium /62^ Sodium’ 5: Corrosivity (temp:' “C) ’^X'C'filoride ^3) Beryllium , /^Thallium r6. iEiOP’(5.day) 7/ ■ ■ Wc^idt, . W Boron- ^4> Vanadium ;7. .^luble BOp (5 day) ■•26;Ffuorjde ' 4^;JCaclmium„ '"^■Zinc, , 8.-: Carl^nacecus BOD/S day) - 27\Hardriess,' Totafas' CaCOX' ^>Calcium?^S;CaC61 ....... - - - ■ 9.7 'Chemical,O^ge.n Demand ,28? Nitrogen,- Ammpnia/as NJ 667Metals/CN ^I’O/pissoiyed'Oxygeri’ 29? N it rbgen > N itrat e, as^ N1 48 i Chjomw m;, Total i : <1: iTotaLOrganlc^Carbon 30?.l^itrogen,;Nitrite. as^) 49/Chromium,-Hexavalenti i68:<Semi-volatiles^ , 1 ki-.Total Orga’nic'Halidesj 31 .' Nitrogen, .Total Kjeldahl as.N - |69>pesticjde^pCB?s; j 1 SliSblids,'^^^^?^ (%')) 32: ^and'Gre^ ’ " .^J-Copp)er JO? Disi< Deliverables ; lA’.SolidsiSeTtleablei 33.:.ph'ehol.r .‘ICLP( 1 ^Solids') .^spend^d” 34'..'Pffps|^6rus ,-T:otar'as, Pz 7-l’;rGlll?/Metals; ’.l8^Sdlids;.Totai: 35> Phosphorus;, Ofth'o.aslP* f^^;Magnesium't 72',TGltP-Pesticides^ I M^^lidX^Wpissc^dj, 36.;_Sulf4tesj ' t tetSolid^TWVo^y S^Sur^iSht^ _ Other:’ Sn . ~Ti-------- Z^:Mq!y&dS^ - ^Nickeli_ ; ____ _ ...J’ .... i-M. . -./a:b; NYC-WTC_000071502