Chain of custody record, Westchester County Dept of Labs, Jan

NYC 9/11 Public Portal Document

ViRC MENTAL SERVICES SAMPLE SUBMISSION FORM MB ICO!)) STC STER COUNTY LABORATORIES AND RESEARCH PDnaa l«.,«l, Now Y,«k WtW. MH (914)231 1620 Fax (914) ?311 //? < i

V- / I Time/Date Set: VJ :;l. , ..^FormA-70(rev.10/01) sample Type,,.,,, I-Y 'A H

■ .<Po,abieS 3 Non Potable Treater, Bottlers: >

'liKTpoiaW.. .com,,, . _ ' ye tan.D.,l.. Coil,,,,;..... A y'/Y . coinntonu: . ...■.: .. ......... . ttE— An,„„w Code. ~ HWS«, S.«.».|l):„ -Ivpoltuscnpio,;.’

Collected From: Bill to: Location's/Tndividual’s Name , Name/Company_ __ : __ Street ■r 7 . tY- /- e/O-B 7'7/ t:

City/St/Zip <■ / 'V t < t __ ;L --O'‘/C- City/syzip: identification of Source Phone#:... Fax#: &.;l'i',:iin'i Poiill / V i ■ t By ■i CA,CH. Bi? Check#:Amounts

BACTERIOLOGiCAt. ANALYSiS Lab#: _ ________________ Lab#: ORGANIC POTABLE ANALYSiS ORGANIC NONPOTADLE/SOLID ANALYSIS __Heterotrophic Plate Count (hemodialysis & all others) __Trihalomethanes (524) _ . Purgeable Halocarbons (624/8260) ,;■■■ Vokitile Hii!oc;iri)oiis (5?lj . i'u.,,,.uiiieAfoinati.:s (624/82WI) __ Coliform P/A (Public supplies) •2^rV<^te^«c« (524) “ 5r:™oHohX"S£'Z80ai, ■ __ Coliform MPN (priv well, raw, stp) B Fecal Coliform (ail samples) Total Trihaiomethane Potential (510) Z Microscopic __ Microextractables (504) .................... ■Citw.iuolUbi.::. :iC!( ti.-rti!, ides 'SM la'wt.Hi.S’.bl) icit-iiioiobipiionyi (SliBAi . O:hcr I’eMKTdob, (SM18/6030) I 1! ■1 ... (■.dnii.iuriliyJi.HMii.o.-Scnn (310 13) ■ Refrigerated?yes no !S (531 __ Glycols in Water _ Acid Extractables (625/8270) . . it I-..'Neutoii LxlracLilikiS (F2i./a2/n)l Chlorinated:? ____ yes no G.;/MS Unknown S.:ai: i-r,’i' Gniorine Res- . .... nigT •1..kites ((»0i;| il ion 'ilils (Mi Total Chlorine Res: H-il.T.iiietic A -.i,!-: (.552) ler;! OP»rPcr,,adnep„„TO3P, “ PH _________ __________ -- -- - ___ — - I RADIOCHEMiCAL ANALYSIS

III “other________ _______ _________

INORGANIC ANALYSIS REQUESTED -1 on#: Coior _ A:;!dity .... Turbidity ... Aik.ilii.ily E Autunrrny ; ' ' ’“scluniubi Z Arsenic .J/E '

E __ -C) ------------------- ---- Barium .^Beryllium /.’ . Sodium ( -Thallium:

Carbonucouus BOD (5 d.iy' ‘iuorid. .... Soluble BOD (5 day) iardnei C.11..WS a..ca.;o ............ ' ■ . Gheniical Oxydci. Demand ni-iw'ivvd OxviPii Jitrogei imonia as N ratQ me M _ Calcium, Ca« ------ -r„r„i ietals/Ci H .... ToLi: OrganL: G..rfcn . .. 7Chromium, Hexavalent olatiies B emi viol iles^ ....... Tol.ll Organic H.ilidns lanic Hahefns '-H t ■]! ' ii-iickilil as N .Gonalt itoppui 1 Ie Is: le( s ■ is! :■< Magne.:un, .olios. To UlO! Ui ■

NYC-WTC_000073150