Chain of custody form, Westchester County Labs

NYC 9/11 Public Portal Document -T -V

EJMVIRpNJMEJ^TAL^ERyjC , ifesfer zovcom 4 2 pana’^Rdad?..Valhalla‘New York'ri 0595^ (^4).593:5575; ' NYS-ELAP No. 10108..' Form A-70 (rev. 1/96)

Sample Type (circle one): , 3. Non PotablejTreafed Bottle j^s: , . 4.,0theX'L^:^.^_^ ;__ . Chain of Custody? yes - no B 2tj£3’| . time/Date Coirected:‘- lt) ~'~2.5 ~Q'I\ Comments-: V OCTg? P K, "7— I . ■ .. ■ ■ Collected By: (Y .-SCrQ -Agency Code:. ■ - PWS #: Source ID:Type Descriptor::y ■«"»>= ■ ■ ■ , Collected proih: Location’s/lndividual’s Name. street | q Ia)P sH" s>vc orP L.i\ tCg IY ’ Name/Company Street city/st/zip V A O') A LL A 9S City/St/Zip Identification of Source___________ - ________________ Phone#: Fax#: Collection Point _ rAT Lf:pr CA,CH, Bl? Check#: -Amounts.

BACTERIOLOGICAL ANALYSIS. .ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS^ Lab#:. ; •Lab#: - ________ — t (circle tests)' .(circle fests); 1. Heterotrophic.Plate . 1.-Trihalomethanes-(524) 1. Purgeable Halocarbons (624/8260) . Count, (hemodialysis & all others), '.- <^Volatile.'Halocarbons^ (524). 2. Purgeable Aromatics (624/8260) . 'vY. 2 2.'Coliform^ P/A*: (pu.blicsuppli.es)j ^.Volatile'Aromatics: (524)'^' 3.'- Acrolein & Ac'rylonitrile (624) , 3? Coliform* MRN, (priy.well,’ raw,'stp);‘ • I ■'4.',Total TrihalometferiePotential' (5^0)- 4;^ l^hthaiates;; (625/8270)'' ' . 4. Fecal Cojifofm' (an sarffples)) 5YMicroextractables_(504) 5.-. Orga’nochiorihe Pesticides (608/8081) 5. Microscopic! . 6\ Pesticides:: (507)' ' ■ . .6'. PCB’s (A'rochlors) ■ (608/8081) ' * ' '^jJ^cToscqpic. l^tiddes/gCB.screen (508). ' 7;?Methoprene,(6ji6) , co. i ) 8?<PC^as:Decachlorobiphenyl - (508A)'. 8., HerbicidesKEPAI 978/8151) ! 8? Other:"_^;___^Li__^^ *‘^Herbades;.(^5n j ' 9; Resticides^(SMI 8/6630)^ -y J • ' i (^l^stiqdesiXKS); I 16. Petrdleurn Hydrocarfion.Scan’ (3.10-13) Refrigerated?'— ■~^ves - - no I ’ pT,Carba'njate.F’esticides>(53l) • 1’1. Glycol^' ' " . ’ , b£:Giyplios^(547)| 12.-Acid Extr~actablesj (625/8270)J ' Chidrihated:?/yes no ... ' 513? Diquat; (549)'' i i3.’ Base Neijtral Extractables (625/8270) ' . J,' Free.Chlorine Res: mg/L 14. Chldrinatidn^Djsirifecti'on Byproducts'; (551)^> /T^C/MS'.Semivo7attle Unknown Scan\X 15.- Hafoacetic Acids\X552), \ ^^Purgeable i^^dcarbons’(DEF) CS Total Chlorine Res; ______ ; m'g/L -- - • - , . ■ u-

f6. Pesticides {swOe^j 16?'Purgeable'Aromatics (DEF) pH. ' 17.' Pet'roleum/HydrqraVbod;Scan (SJ^O.-IS^-' •17. Pesticide^eC^’s-rcbEF) . 18. ofer: - - ■ . 'x.-- .. ■ i 8.6ther:i^, «r- ! ■ .. • . . . . . . - • - . •* i

INORGANIC ANALYSIS REQUESTED - Lab^: ..(circle tests) *. ' .'1. Color •. v; 20?Acidity( ’ 21.-'Alkdlipity. as CaCDOs. 39MlurTiinum - ^Q^ntimony .’otassium 2. Turbidity J ■6O'.*Selenium 3. pH '22?;,Bromide'\; ' ' 4J?Areenic . • 61. Silver 4. Conductivity 23? Bromate/Chlorate/Chlorite. ' A^Barium- Sodium' 5. Corrosivity (temp: ' - °C) 24?Chlonde •'^^eryllium ^^eryllium . hallium ^6. BOD (5 day) . 25,' Cyanide ;? 44.’Boron Zariadium 7.>Soluble BOD. (5.day) ’ Fluoride’ 45/Cadmium ■. 65:-Zi^ \ , '8.' Cariaonacdous b'od'. (5 day)^ ■27'.'Hardness? Total as CaCOa? 46. Calcium? a^C^COs; GLP/------- • gY CnemicaLOxyg'en'pema'n^dj ' 28.v'Nitrdgeh, Am'rnonia a's N. ^^^alcium^Ca^y f66?Metals/CN i. ; 10^3 Dissolved .Oxygen 29.^ Nitrogen',■iNitrate 'as.N/ 48.’Ch'rornium;- Topi/ ■67/; Volatiles;' : -I VyTotal Organiq Carbon ■ 3().<Nitfogen,fNjtrite,as;N/‘ 49?GhrorTi'ium;;Hexayalent) !68.’Semi:violatiles- • . I^Total O^'anjc Halides 31 .'Nitroge.h.’.tqtarf^eldatil'as. N, (So^BaltS 69'.'Pestfci3es/R(^’s- 1^’Soiids?/^ercenf (%j^ . . 32:pil'ar)-^ease; -^opperr 70. Disk'; b'eliverabies. i^^Soii'ds',-.Settleable ~ ^I Rherfc^ • . „ 3/; Rho/phoTus Total :as;R/ ’^L'ead? *fcCP) .5ffsolids;. Suspended I, i .i6.‘.Sblids>f6raH 35? l^hbsphprusnOrtho.asIP? ^f^agneqiumy 36; .Su!fatesi ’ ^^angjanese/ 172?TGL4?-'Resticidesi J iVcSolidsMo.taLDissolvedV *73.'jeL’P-R^rbicides, ' 18*^k^tTp^>Volatn<i 3WSurfactanfs> Sg^ercuryj i’7,4>TCLR-y^tiles; -Q^ther:: 175'>tCL^-BI^ - - . -fciii—iiw WllciJeft ' ■». ., •• _____________ » • »»— »• 2_____ __________________ » *** .»A»?-r«»«

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