Chain of custody record for Westchester County Department

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSIONFORM . xHACCo."—''-"- ^ster WESTCHESTER COUNTY LABORATORIES AND R^EARCH 3v.com 2 Dana Road, Valhalla. Neiv York 10595 Tt (914)231-1620 Fax (914) 231-1772 NYS-ELAP No, T 0108 Time/Date Set: Form A-70 (rev. 10/01)

Sample Type (circle one): -f '"^Potable 3. Non Potable Trea^d Bottle #'s: 2. Non Potable 4. Other ____________ Chain of Custody?___ Yes Nd Time/Date Collected: 7- Y y' * f Comments: Ibi_____ ' Collected By: Agency Code: PWS #: Source ID:. -Type Descriptor: Collected From: , Bill to: Location’s/lndividual's Name ;; Name/Cornpany Street_______ _________________ Street________ ___ _ ' Citv/SVZiD' \ . . T city/st/zip; _ Phon^: ■ I Identification of Source L T^Wl^tFax#:'

Collection Point _ — I ,.CA.CH: BI?\

BACTERIOLOGICAL ANALYSIS Lab#:_________________ " ORGANIC POTABLE ANALYSIS^ __ Heterotrophic Plate Count _Trihalomethanes ((524)' '' " ’ / ' (hemodialysis & all others) - __ Coliform P/A (Public supplies) Volatile Halocarbons '‘(524) '..’A^’Zu‘ige'ab!e)5^mah(»Y(624/g^ __ Coliform MPN (priv well, raw, stp) __ Volatile Aromatics (524) • _i.T Acr6fein'&'AcfyldnitrileY(826^ • :; T’ ' * __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) -_J drgandcBdrifiS^ l’e^icide^’(6;()d/8081) ' Microscopic _ Microextractabl^ (504) /. ,; , __ PCB:s (Arochidrs) Y608/808l)Z^^':T .< ■ __ Macroscopic _ Pesticides/PCB screen(508) Herbicides ■(SMl8/665S),gl51)'TT:O>rt _ PCB as becachlqrobiphenyt (508A) T' \ _ Othdr. Pe^icid^ ;(SM18/6630) _ API __ Other:_____________________ _ Herbicides ,j(515) : ' T •' Petroleum Hydr6carbon Scan (310-13) _Pesticides (52?) -.7 Y : J __ ■ .Glycols in'VVaterT<^^>,:'--.';'Y^ 'T.>Y ''Y Y Refrigerated?_ ;_ yes no __ Carbamate Pesticides (531) . ,;Y. _ Acid'Extradfa6les -^625«27b)? st J ■i _ Glyphosate (^7)- ■ ‘ Y _ Base Neutral Extractables/(625/8270} .J Chlorinated:?yes no _Diquat (549)" . _l/GC/MSUrikriowri.Scbn 'Y < ., ' Y- Free Chlorine Res:mg/L _ Chlorination Disinfection Byproducts' (551)I _ Phthalates (606MS),' • . M Total Chlorine Res:mg/L _ Haloacetic Acids (552) __ Other: ' y - '/T' ■■ ■ ' ■ __ Other Pesticides (SMI8/6630) pH. _ UCMR List -1- RADIOCHEMICAL ANALYSIS _MtBE Only (524) __ Radon ■ - Other____________ ;_________ ",v -A.‘

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity -) ■■ Aluminum __ Potassium 5; ; __ Turbidity __ Alkalinity ■ I '^Antimony ;,:J^'Sei^ium '—pH __ Bromide Y Arsenic ' .±- Silyer,, __ Conductivity __ Bromate/Chlorate/Chlorite ^Barium __ Corrosivity (temp:°C) __ Chloride -• .‘JS Beryllium A; / -^Thallium ’V 7 .; _ BOD (5 day) __ Cyanide Boron Vanadium _ I Carbonaceous BOD , (5 day) __ Fluoride __ Cadmium , ; ^zinc' T _ Soluble BOD (5 day)' __ Hardness, Total as CaCOa __ Calcium, as CaCOs __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*^ CLE . __ Dissolved Oxygen V _Metais/CN , __ Nitrogen, Nitrate as N .^Chromium, Total _ Volatiles , J __ Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent JiL’ Sehii-violatiles ''' __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N -Cobalt __ Solids, Percent (%) _ Pesticides/PCB’s __ Oil and Grease ✓ Copper __ Solids, Settleable __ Phenol Iron TCLP . __ Solids, Suspended __ Phosphorus Total as P _Lead. T _TCLP-Metals , __ Solids, Total __ Phosphorus, Ortho as P _^^agnesiurn __ Solids, Total Dissolved _TCLP-Pesticides ' - __ Sulfates Jl Manganese __ Solids, Total Volatile _TCLP-Herbtpides, __ Surfactants Mercury , y'Other:_____ ____________ _ TCLP-Volatiles j/ /’*-' • _ UV254 Molybdenum . ?<»• ___ NYC-WTC_000072910