Chain of custody record, Westchester County Lab

NYC 9/11 Public Portal Document

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III IB ENVIRONMENTAL SERVICES;,SAMPLE SUBMI.SSION FORM ■wESfCHESTER.COUNfY^LABdRAtoRIES'AN^^ 2 Dana Road'Va^a^ .* ■ Z : ^JMihester County ; ’ ' ' ............' (9i4j59^5575>^ . ’ NYS-ELAP No.10'l08 ' '^^^'e/Date Set:'- . ■ Form A-70 (rev.’1/96)' -

(J/Potable . 3? Non-Pot^le Treated -Bottle ys:"- ■ - ' ' _______ ;______ .'2.’-N'on-l^tab|e/.Z 43 Oth'er • ; • - ~ -' ■ .Chiain of Custb'dvy^- Ygs' - ’no". " ; 1 ' fime/Date Coliected:^ - - ■ Comment^?________ Y - , , ,. . ______ • , “Collected By: - '/N Agency Code:- ■‘• 't.": PWS #:’ - - “7. . -' < • Source ID: ~ ■ Type Descriptor: . - . ...

Collected Frbrn! ; t/ BllUb: ' Location's/lndividual’s Name 1 t Name/Cotnp'a'nyj_\ ■ ..

••street'; . C«y/SVZip.4£Zt/4V14U4^j2^^]^^ City/St/Zip Identification of Source ' . ' ' ■■ ■ -__ L_____ ;____ „ Phone#: - ■/- Fax#: -s _Collectior<Point2X=i=^=L2^^22j;;^_c__=^;==^==^_E2^Z£K^^i2^^^ Check#:, ' ' Amounts ' - • -'A ■' Z ' •'- Ms . *. BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ''ORGANIC NONPOTABLE/SOLID ANALYSES Lab ."('circle tests) ■’ V'Z'' A. ' ' (circte test's) ' . ' ‘ •1. Het_erotr6phi’c'P.!ate V •’ 4/'Trihalomethanes.(524)l Purgeable^Halpcarbons (624/8260)' pv j ■ • Count {'hemodialysis & -all others), Z^ yolatile Halocarbons (524).. 2. PurgeaSreTArpmaUcs (624/8260)'' u ■’ -‘2/Co!iform'P/A’ (pdb)ic-supplies); '■ I Volatile,Aromatics’(524). 3. Acroiejo^j^^onitrile (624)/ ' i^. ^?Coi^orm MPN-(^^^ell.vr^WAStp) 4. Total Trihalorfietfiane^Potentiat(^t(^J 4., Phtfi^f^(606/&366)^ ' ;4/'FecXl Cpliferm''iali?s’a^ 5.- MicrdextractaSes'(504)') 5^ '6r^anbchl6rine>esticide^(60'^’^^ i'wj J ■'5'Microscopic/ '' .(Pesticides (507)’) " ' \6^acr'oscp^jfe; ■ . © eeslicjde^RCBjscMedXSOS)^ 7< Rp?b1cide£(S^;i,a{664^^^ 18?. pGB‘asjDeMclilordbiphenyl;(§^^ 8> Other;Pestici^s2(S^48>J^3P)J -. :• «-■

Refrigejated?^y.e.s. .ntfi.’ f W-.Csff^^§:i^^ides;(53jj; 11. ^d ^actables’{625/827.0)\ ; ; A)- il^Gl^c^te(i{547)! 12)Bake^tr^Ext^able^(62^70))';d^^ Ch Ipnn ated?Z;;:=;rryed; X.. no- (13>DiqUat‘(5X9jf ^GG/MS;lJr)!«^n Scan,! ; ; v; |l'4i^cRlodhat(otrl^^nf^tion’^^p^^ T4.\^urg'eabl^e;Halc^ajb6ns _g: F re e'Ch Iori he.R^:L '■ ^mg/L' ll5?.Haldac6tic’Acrdsj(5.52)V *’ . . 1 SJiSurgeaSe/ArpmaticsK .1^.6tKereksticidSS('Sli!jHdr^^^ -• T6Zf’esticides;(DEF)} " ’1 total Chlorine Res: .1,7. P'^oleunWyjlrj^Bon-ScanX^pMs)}. 17<PCB.'s;(^rochlprs);{pEF)'- ■,

■ INORGANIC ANALYSES REQUESTED ■ Lab#; .- ' I saJ- ;(circle tests') i ‘ 20.'Acidify; ^LAIumirium/ f^^^^tass'ium> 3' Color;-;' 2. 'Turbidity 2.V,.AIkalinit;^as.CaCO3 '. (S^Xntihnbny) I pH .: " .22./BromidejL^ 41; Arsenic; /62'>Sd;dium'r .1I 4.; -Conductivity, ■'' 23.<^omate/^lorate7Chlorite;^ J^'^ium;, ■ 5;' Corrosivity (temp: ■ :*C)'' 2'i^’?Ch'loride1 ““ “ . i^S^feeryHiufn' \ e^'M'aliiumj •.6.=--BdD (5day)''- ' ’ 257Cyanide) . 44?*^rpn7 -7; Solubje^ob (5 day)’; ■ ^MFIubijd^’ 45:;Gadmium1 _ ■ i65>>2nc^ - - ’8.', Carbonaceous BOD (5 day)' 27? Rardness;-jTbfal,as^C^GO3> 46], Calcium,'asjCaGO's) ■^’9.' ■ cTwniicaL6Sygeb Pemahdji 28^NitrOgen'?,A^rnpnia asjjjlj <^c/lcium,-.Ga"-^ : ^6zMetals((?l)Gr - v I ’lO^DjssplyedtOxygen.' 29)N it'fp^fi) NitraierasjJ^ r •""-•■■ 48>Gtirorniurn,yJi;ota!/ , ' 11: Toral 'p'rganicjGaftibn' ^i’Nrtro’ en7 Nifrite/asj-NJ 30?;Nrtrbgen7 Nitrit^p's.N) iJ^'-Ch'rpmiumXBexavatePf/ , 68-'.SemUY^I^es')^, * , 12' Tofai;drgariiC;Halides> 31.;Nitipgen,';tpta(iK]elda^^^^^^ . - >>'■ 3 '( UOKDisIC’Delit^r^sv A;S^i^;.pdr^^(%5> '- 32;'Ojl'and.’(3j:ease) ^^C^gev »Splidi-,§ettleable) ' 33el^n^' VTCLP? ■" ■ n Solids:Tuspindedr 32: PhdspHofusr Tolabas'^ 'j;i55TGli^MetalsR^^iW^ ■ •ms:^ids>.Tbfa1} •MplTosptToru^;Orthp^€^ ' r72>^Lpl^^ydes);-• I 17? S^^ TptaCtisso!:^ 36i§uifate^ ' . ■'•^?duj1'act^ts> ■ ; /- ■’ ;745TGL;yplatiles4^Z'^-^‘^ f- &. ■

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