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

NYC 9/11 Public Portal Document

Alt a , ENVIRONMENTAL SERVICES SAMPLE SUBMiSSiON FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 * 11 (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 Timo-'Dnt'? Set' Form A-ZO (rev 10'01; I -7 ZZ'?. ■?' , z V •■-.■■Zy" Sample Type (circle one); (ZPoi.ihi^Z 3. Non Potable Treated BJ;,7OvkiLL’ / -ZZJXt_ Chain Of cu^ Yes ' No ’ ' " ZN^Potabic 4. Other........................ ,......... _ Time/Date Collected: Coinmenfs;.......... Collected By: r \< eZ?/" Agency Code; PWS #: . Source ID:Type Descriptor; Coltected From: Biii to: Location’s/lndividuai's Name A/ /> (I'-- I_____ Name/Company _ Street M OZ; Z UKT Z'K/uZ City/St/Zip /Z|iiSB|/il|}B8ZBZ Fax#: Collection Point CA.CH, Bl? Check#: Amounts

BACTERIOLOGiCAL ANALYSIS Lab#:^ Lab#:.................................. ............. ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) Purgeabie Halocarbons (624/8260) <• Volatile Halocarbons (524) . Purgeable Aromatics (624/8260) __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp) _^olatile Aromatics (524) _ Acrolein & Acrylonitrile (8260) __ Fecal Coliform (all samples) __ Total Trihaiomethane Potential (510) _ Organochlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) PCS':: (Arochlon.) (608'8081) __ Macroscopic ___Pesticides/PCB screen (508) „ Herbicides (SM18/6630.8151) __ PCB as Decachlorobiphenyl (508A) Other Pesticides (SM18/6630) ... AP! __ Other:, __ Herbicides (515) Petroleum Hydrocarbon Scan (310-13) __ Pesticides (525) Glycols in Water Refrigerated?yes no __ Carbamate Pesticides (531) „ Acid Extractables (625/8270) Chlorinated:?yes no __ Glyphosate (547) _ Base Neutral Extractables (625/8270) _ Diquat (549) Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) Total Chlorine Res:mg/L __ Haloacetic Acids (552) zX ‘ ’_______ __ Other Pesticides (SM18/6630) _ pH___________ ______________ UCMR List 1 ________________ ■rADKTCHEMICAL' AN/U.YSIS """ MfBE Only (524) —Radon __ Other'

INORGANIC ANALYSIS REQUESTED - Lab#; __ Color __ Acidity __ Aluminum '__Potassium _ Turbidity __ Alkalinity Antimony __ Selenium __ pH __ Bromide __ Arsenic __ Silver __ Conductivity __ Bromate/Chlorate/Chlorite ___ Barium __ Sodium __ Corrosivity (temp;_____ °C) __ Chloride Beryllium X Thallium __ BOD (5 day) __ Cyanide _ Boron _ Vanadium ------------ __ Carbonaceous BOD (5 day) Soluble BOD (5 day) Fluoride Hardness, Total as CaCOs __ Cadmium ___ Calcium, as CaCOa ■ __ Chemical Oxygen Demand __ Nitrogen. Ammonia as N __ Calcium, Ca« __ Dissolved Oxygen __ Nitrogen, Nitrate as N ___Chromium, Total __ Total Organic Carbon __ Nitrogen, Nitrite as N ___Chromium, Hexavalent '-violatiles Nitrogen Total Kjeldahl as N ^Cohn!^ Pusncidos/PCB's^ - _ Oil and Grease Copper

zSX»i«-«p fts. ■ _ Solids^ Total Volatile ipi ‘TC7 ESSf- . Saa. kiirZi _______________ . . ___________________ J_______________

NYC-WTC_000073236