Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

III . . ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■ ; )\5coni WESTCHESTER COUNTY LABORATORIES AND RESEARCH " 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 0 NYS-ELAP No. 10108 i/Date Set:’ Form A-70 (rev. 1/96)

Sample Type (circle one); '7 ' jl Potable 3. Non Potable Treated 2. Non Potable ' 4. Other ; Chain of Custody? ...... yes ... no Time/Date Collected: Comments: . ... / Collected By: HgYingr Agency Code;! PWS #:______ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name KlVC '"('7-BP Name/Company Street oof:/,-,::./ Street _____ City/St/Zip Identification of Source I Phone#:. . Fax#: Collection Point. "feUG CA.CH, Bi?^ Check#:^ Amounts

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPO1 ABLfcVSOLll' ANALYSIS Lab#; f|^ijBi|fisO|BBBBB:ililiBBBBffBBI (circle tests) Hilf 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Ml Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) <3- Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4 ri.:t.j,ie. (025'32-0) 4. Fecal Coliform (all samples) 5. Microextractabtes (504) 5. OnnnrrnchlorirrcPesticidns (608/8081) 5. Microscopic 6. Pesticides (507) 6. PC«s (Amchfomt (608/8031) ’^4i||cros3opic 7 7: Pesticides/PCB screen (508) 7. Methoprene (616) 8. PCB as Decachlorobiphenyl {508A) 8. Herbicides (EPAI 978/8151) a. Other:___ 9, Hert'icides (516| 9. Pesticides (SM,8/6630) no) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated?..... yes no- M Carbamate I'..- - r-U. Chlorinated:? yes no I '. /:;;n 12. AAlFxfoici.kA :.: (G/'OnPTO)

Free Chlorine Res:: mg/L

Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SMI8/6630) 16. Purgeable Aromatics (DEF) pH 17, Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF) 1S.Other:_... ....... _____ _____________ 18. Other;

INORGANIC ANALYSIS REQUESTED - Lab#;.7 ..:''*:':"B (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs C 40) Antimony 60. Selenium 3, pH 22. Bromide Xi. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chiorite 42. Barium ,62. Sodium 5. Corrosivity (temp:.°C)- 24. Chloride 03: Beryllium ' ^3. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron (^4. Vanadium 7. Soluble BOC (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day)! 27. Hardness, Total as CaCOs 46. Calcium, as CaCCta CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^ 66.Metais/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 11. Jota’ Organic Carbon 30. Nitrogen. Nitrite as N 49. Chromium. Hexavalent 12.'Total Organic Halides l^olids. Percent (%) 31. Nitrogen, Total Kjeldahl as N ^60,Cobalt 32. Oil .n:. C ease 31 Copper I gfcolids, . HhAnni 33. Phenoi .by. 52. Iron TCLP Wsolids Suspended 34. Phosphorus Total as P 53.Lead , 71 JCLP-'Metais "16. Solids; Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-Pesticides 73.TCLP4terbicides 18. Solids,-Ibtal Volawe 37. Surfactants 56. Mercury 7J. TPI P~VnlaiilPc r19. Other: - 38. UV254 (spMotybdenum /

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