Chain of custody form, Westchester County Labs

NYC 9/11 Public Portal Document

i' ’ ftf; hestefr :'- , ■ENviRdi^ErinAyBEfwi^s'^^pL^^ p . ov.com wESTCHESTER^couNTy Caboratori^anp;r.es^ Vj, <V I 2 Dana Road. Valhalla; New York 10595 • ^7 . (914) 593-5575 , NYS-ELAP No. 10108. J^/Date Set: • Form A-70 (rev.1/96)__ ".'I titt ■/ t c;;- 07? $■ r > 4^6 z i J, - Sample Type (circle one): '?1. Potable^ , 3. Non Potable Treated Bottle #s:,. 72." Non Potable' 4. Other; Chain of Custody? _ yes no ^Tirhe/Date Collected: J? O _________ Comments: ■ < ’ Collected By:Az7L^ ti Agency Code: PWS #:: Source ID: _ _____ .Type Descriptor: Collected From: Bill to: Location’s/lndividual's Name _ __J±±^_bCy^_ _ Name/Company street Street_________ City/St/Zip _ City/St/Zip ; Identification of Source____________ _V_________________ -■ Phone#: Fax#: Collection Point __________________ CA.CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________________ _ Lab#:_________ .(circle tests) (circle tests) , 'l.’ Heterotrophic Plate < 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis &,all others) Y'?7jVplatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) s,J>v6latile Aromatics (524) 3. Acrolein & Acrylonitrile, (624) 3. Conform MPN (privwell. raw'stp) 4.,Total Trihalomethane Potential (510) 4. • Phthalates ■ (625/8270)' '• 4. Fecal Coliform (all samples) ♦ 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic Pesticides (507) . 6., f^CB’s (Arochlors)’ (608/8081) - eJ^croscopic * Pesticides/PCB screen (508)^ 7. Methoprene (616)^ PCB as Decactilorobiphenyl (508A) . ‘ 8., Hefbickies (EPA1978/8151) Bother:■' Herbicides (515) 9?Pesticides (SMI 8/6630)" Refrigerated? yes no Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) 11. Carbamate Pesticides (531) 11.Glycols , Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (5^) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:_L_L^ mg/L 14. ChlorinatiOT Disinfection Byproducts (551) (5a?C/MS Semivpiatile'Unknown Scan Total Chlorine’Res: ' mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) -----c 17. Petroleum/Hydrocarbon Scan (310-13) • 18. Other: 17. Pesticides/PCB’s (DEF) 18, other;.

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) ,. ; - ' - *4^*. F -i.’ coiof- 20.'Acidity U- 39. ■Aluminum . (^..-Potassium '2. Turbidity "'. 21. Alkalinity. as-CaCOs /^O^ntimoriy 60. Selenium ■’ .3- pH - 22. Bromide 41. Arsenic - 6VSilver ‘ '4. Conductivity 23. Bromate/Chlorate/Chlorite, - 42. Barium •- (^2? Sodium ’ 5. Corrosivity (temp:®C) 24. Chloride Beryllium <^63?-Thallium ■ ,6. BOD (5 day) 25. Cyanide ’ 44. Boron . /64,)Vanadium • 7. Soluble BOD (5 day) ' 26.'Fluoride 45. Cadmium .f , 65.-Zinc 8. ■ Carbonaceous BOD (5 day) 27. Hardness. Total as CaCOs 46. Calcium, as CaCOs '. CLP - ■ 9. Chemical Oxygen Demand ■ 28. Nitrogen. Ammonia as N (^7< Calcium. Ca*? \ 66. Metals/CN 10.’ Dissolved Oxygen, 29. Nitrogen. Nitrate as N^ 48,Chromium.’Jotal’./. = / 67/Volatiles;. s. 11. Tota^Organic Carbon 30. Nitrogen. Nitrite^s~N^ 49. Chromium? Hexavalent 68. Serhi:violatiles; . 12.'Totaro.rgariic Halides - • 31. Nitrogen. total Kjeldahl'as N f50.'Cob''alt. , 69? Pesticides/PCB’s ;, 13.(Soiids. Percent'(%), ■ • 32. .Oil an Grease z . 51jCopqef; j70?DfeK’ Deliverables, .^t?!ids.>ettleab|e 33.;5hehol.. ' /52/)ffdrr> ' . . JTCLP; 5 - 1^R'6lids?Su'spended’ '' .3^4rfyi^pjwus Total as-1^ ' ' ’ l'^Soiids;Totar! .35?5hpsphdrus;Ortfoas;f^ ’’ (Sf^Me^esium? i^^YCLR-Pes^i&desF ; IT'.- Solids/.To’arD^ssolved? 36/;^at^ ■ '? ■ . 73^TCLP,:Hertiicides' .t-^iSoWs.* ToTafvoJaJU^ ,. t (WOthe'r:----5.fc-.. --------- *• ■! I/:

NYC-WTC_000071878