Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

' gg A' ENVIRONMENTAL5ERVICES SAMPLE SUBMISSION FORM ' ■■■ ■ ; ? , WESTCHESTER county Laboratories AND RESEARCH ' 2 Dana Road, Valhalla,’New York 10595 (914)593-5575 . . NYS-ELAP No. 10108 ' ^^Ble/Pate Set: __________ ' .■ ' - • ________ :______ ■ ■________ Form A-70 (rev. 1/96) bampjgjxpe (circle one): <^Potabl^-'3. Non-Potable Treafed Bottle #’s:.C ■

2.. Non-Potable?? 4. Other,;______ ' Chain of Custody? ■ yes ■ no Time/Dafe, Cnllected: ‘ /Z> '77rr> f • ' Comments: •Cnllfictfld By:?^^^ '” :__ Agency Code;— PWS #:___________ Source ID; .Type Descriptor: CollectedFrom:, ’ ’ Bill to; I Location's/lndividual's Name NS C. Qt P_______ Name/Company Street 19 L C. ^^6 Street City/SVZip_ •.y^hKtucc kN 10^9 r City/St/Zip’ Identification .of Source _______ ' Phone#: Fax #; Collection P6iht_ DfZ- 7ft I CA. CH. Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#;__.IrLiL_lr_ri_,___ ___ ,;.' Lab #:'- - ' -(circletests) . '< ... (circle tests) ' ' • r Heterotrophic Plate, ■ . , 1. Trihalomethanes (524) ■ 1. ’Purg0ble Halocarbons (624/8260) .Count'(hemp'dialysis & all.others) Volatile Halocarbons (524) 2. Purgeable Arorhatics (624/8260) '2. Coliform P/A (public supplies) ■ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform .M.PNj'(pfiy well?raw, stp) 4. 'Total,Trihajorfiethane Potential (510) -4. Phthalates (606/8060) ,4i Fecal Coliform (all samples) ■■ 5?'Microextractab'les;(504)- . 5'7 b'rganochlorine Pesticides (608/8080). Lt ' 5. Microscopic 6. Pesticide^ (507) ' ' ■ 6. PCB's.(Arochlors) (608/8080) ^^acroscopic - @ PestJcide^s/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 14 ■'ft: '8. RGB as'^DecacljIorobiphenyl (508A) 8. Other pestipides(SM-.18/6630); " , ;^Het^d^.(515)'' , 9. Petroleum Hydroc'trbon Scan (310-’l 3) ^£))Pesticide's..{525)’ ■10; Glycols in Waief .. v-.. , Reffigerated?-LU ■ ’.yes" ' no . ’ 11; .CarbajTi'ate' Pesticides (531) 11? AcidExtractables. (625/8270)' \ , ’■ 12.-B.^as^Neutral Extractables (625/8270)' <:3 ' . Chlorinated?: ■ vfes ' Ino ’ 13' Dig'uaf (549) j t^GC/MS^Unkn’owri'Scan'" w 14. Chlorination'Disihfection Byproducts (551)' 14;Purgeable.Ha&arb6nV(bEF); . Free Chlorine Res: mg/L 15.'Haloacetic.Acrds;(552) ■ 15.\l’urgeable'Aromatic£.(DEI^ •' / '1 e". Other Pesticides (SM-18/6630) 16.’ Pesticides'(DEF?i , total Chlorine Res:' .mg/L 17.;Petroleum/Hydroc’arbon Scan (310-13) .17.*PCB’.s;(Ar<x'h'lors);(DEF) .. i

pH,•: L ■: . »A' *»■ A •

INORGANIC ANALYSES REQUESTED - Lab#:. •i '■{circle tests) V' itsa i 1; ' Color 20. Acidity ' • -39. Aluminu'rfi ^^Potassi'um^ 2.- Turbidity 21. Alkalinity, as CaCOg (^^4^ Antimony bOi Se'lenium^ TJ*-' ■ 22. Brorriide 41. Arsenic,; 61.-Silver. J -4., Conductivity 23. Bromate/Chlorate/Chlorite 42<Bariurn Sodium ■■ ■‘5. Corrosivity (temp: .°C) 24. Chloride ^SJBeryllium' ^^thailium ,6.' BOD (5day) ' .. 25. Cyanide StiT Boron Ze^Vanadium. , 7; ■ Soluble BOD (5 day) ;. 26. Fluoride.,. ..... ......... ■ 45. Cadmium ■ ^^■Zinc- .1 Carbon'aceous BOD (Sdayj. 27. Harness',^otal,as CaCOa 46. Calcium, as CaCOa CLP ■ •9t Chemical.Oxygen.Dennandj^ 28., Nitro.^gehT.Amrnonia as N . ., ^Calcium, Ca/^ ' . ,66.'MetalsZcN? jTO/Dissolve'd^Oxygen' 29?Nit'rog^; Nitraie as N Ch'r'dmium', Total 67.\Volatiles’ py} Total OrganicjCarbbn CO^NrtrpgenijMiUite'^as N. ' iff Ciirbmiurh, Hexavalent ^;:S^ij<olatiles.^ ■ Total Organic Halides. .6^:P^ticJde^CB:sx ■ “^lids<P^htT%£ 3^giP5nCGc^e? ' Copped 70:^Disk Deii^bles^, „„ |Bbirds;.Settreable> .^3?Ph'enbl^ . (§>lfoni., TCLPr “ ' . Spljdi} Sus^endedJ ^VLeadA ;71. TCLP;Metalsi ’

I-S ■®^'''®'®9T<^ial^jss6lyed> , . • 35; Rh6'sphpru?;;Ortl?p;as.P,. SeKSuffgt^sy ,72;TCL’p-P?s^cides3 =7'3?-ICLR'-HerBicides! 1) 1% TblaWplSili^V. 3Z/ Sur1act’a'hts^ fWcLR^til^ - (O^Ab^ybaej)uj^> ’75sTCLR;B.g.^<. . ’’ft ■-mC. '' .^.Nicke^'„ ii L «hS>?( j' I V’’*■ LtTJtf' NYC-WTC_000072057