Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document ae pee LTT Leet Tar tfemer orag mrsanne one wet oy + 3 tye © pet ge sO ee ae aad weet 6ae ea ' eer wn? moe ys - see pote * oa wat " ate "ENVIRONMENTAL SERVICES SAMPLE: SUBMISSION FORM” , Toa eee i pub , WESTCHESTER COUNTY LABORATORIES: AND. RESEARCH’ i ar yi: ap we . <.° "2 Dana Road, Valhalla, Néw York” 10595" en “uot Qe "sate, (914) 593-5575 es nee pees Pore ra LE -ELAP No. 10108 (Qe Set: ot Form’A-70 (rev.1/96) - 5 (9535 Talhah 3, | Sample Type (circle one): . ran eey ay KG a 30,7 T4," Q Q~1e Was om (1,Potable 3. Non Potable Treated ‘Bottle #s: 2.Non Potable — 4. Other " Chain’ of Custody? ___ yes __no —_ ’ ; =—s ete Time/Date Collected: _ |“ 40 / 16 -if)-G@) Comments: mete ; Collected By: Waanor Agency Code: PWS #: - ‘Source ID: Type Descriptor: Collected From: we, Bill to: , ee Location’s/Individual’s Name _ yc PE ny? Name/Company : 3 ~ street_1% Westia Ke Driv" Street . citysvzip__Ve nella, BY City/St/Zip Identification of Source. - : Phone#: Fax#! , Collection Point_ (2G GH = CACH, BI? Check#. Amount$ BACTERIOLOGICAL ANALYSIS Lab#: (circle tests) 1. Heterotrophic Plate Count (hemodialysis. & all others) 2. Coliform P/A (public supplies) 3.-Coliform MPN (priv well, raw, stp) 4. Fecal Coliform (all samples) . Microscopic roscopic 8. Other: ‘| Refrigerated? ___ yes ___*no Chlorinated:? ___yes___sono Free Chlorine Res: mg/L Total Chlorine Res: mg/L. ORGANIC POTABLE ANALYSIS Lab#: ‘Circle tests) ale -Trihalomethanes (524) AY ‘Volatile Halocarbons (524) U3" jVolatile Aromatics (524) “Total Trinalomethane Potential (510) .*Microextractables (504) e 2Pesticides (507) “Pesticides/PCB screen (508) . PCB as Decachlorobiphenyl (608A) ‘ Herbicides (515) BS Pesticides (525) : 11. Carbamate Pesticides (531) | 12. Glyphosate (547): ° ° 13. Diquat , (549) | 14. Chlorination Disinfection Byproducts -(551) 15. Haloacetic Acids (552) ‘| 16. Pesticides (SM18/6630) : 17. Petroleum/Hydrocarbon’ Scan (310-13) aby : “ ad $ . 12; Acid Exttactables »(625/8270) ORGANIC NONPOTABLE/SOLID ANALYSIS ae ‘, a “eye : Purgeable Halocarbons ° (62418260) Purgeable Aromatics (624/8260), Acrolein, & Acrylonitrile $(624) Phthalates (625/8270) } Organochlorine Pesticides: (608/8081) PCB's (Arochlors) (608/8081) Methoprene, (616), ~ Herbicide’ (EPA1978/81 51), .” Pesticides ; (SM18/6630); "10! Pétroleunt Hi/drocarton:Seain (310-13) 11! ' Glycolst 4 ‘ FO MNAHARONS - Base, Neutral Extractables (625/8270) ) cms’ Semivoiatile Unknown Scan % Purgéable Halocarbons (DEF) 16. Purgeable Aromatics (DEF) 16, Solids; wlotal; 357 Phosphorus; Ortho"é as P 54! Magnesium pH 17. Pesticides/PCB’s (DEF) ' 18. Other: 18. Other: = — ra =. ral =» "INORGANIC ANALYSIS REQUESTED - Lab#: be Der Tike (circle tests) few 1. Color 20. Acidity O 5 39. Aluminum , . Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 80. Selenium "3. pH 22. Bromide 41. Arsenic 61.'Silver 4. Conductivity 23. Bromate/Chlorate/Chiorite 42. Barium 62. Sodium 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide - 44.Boron — ,64, Vanadium 7. Soluble BOD (5 day) © 26. Fluoride 45.Cadmium 65° Zinc ‘ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs - CLR 9." ‘Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47.Calcium; Ca*? :66. Métals/CN i" 10." Dissolved Oxygén; _ +29. Nitrogen; Nitrate as N ‘48. Chromium, Total 674 Volatiles; ; 11:Total Organic | Catbon, 30. Nitrogen, Nitrite as N .. "49, “Chromium, ‘Hexavalent 68: Sami; violatiles, ae 12/7 Total Organic F Halides 31: Nitrogen, Total Kjeldahl as N, 50. Cobalt 69: ‘Pésticides/PCB’ S; , olids; Percént (%): 32. Oil an Grease 51.Copper :70. Disk Deliverables - lids, Séttléable , 33. Phenol 52, tron "| tole’ wa Solids, Suspended. 34. Phosphorus Total as P 53, Léad 4 i AsTCLP: ciMatals) ; 72. TCLP: Pesiicidés, 317. Solids? Total Dissoived, | - 36.’ ‘Sulfates “55, Mariganese* . - " 18 Soliag) Total Noiatile bo 37: Surfactants . . » '56-Mercury Ak a Tou Hetoiea j 1skother wwe tee et on + 98:UV2543 Hs “57%Molybdenum, —* TGBBNAS: : ¥ 5B. Nickel)“ | |i75°TCEPEBNAS) # BS Fe et oe Boo ne tet hs x $i 4 ae alles aac ‘stele th, fet Mee, ce sigh sink NYC. wic fata