Chain of Custody Record, Westchester County Dept of Labs

NYC 9/11 Public Portal Document ‘A A

EijiyiRONMEN SEBVICECsAMBIbSUBMISSION FdRMj ' Westchester;county laboratories and research t ~ 2 Dana-Road, Valhalla, New^York. 10595. (914) 231-1620. Fax.(914);231-1772, " IIS^ NYS-EL^.NoJ.4gW8 . Time/Date Set: FormA-^(Y(rev.10/(y) rt'

Sample Type (circle one): Potable J) 3. Non Potable Treated Bottle " 2^ Non Potable 4. Other Chain of Custody? -Yes’ -No;

r •iL ^Tirne/Date Collected: Collected By: ■ - * / ,-S Agency Code: _ • _ Comments:; PWS #: _____ Source ID; i .Type Descriptor: Collected From: Bill to: Location’s/lndividual's Name . hr A Name/Company; street / '■ I ,■ A.. I L-AV < hZ _ Street ______ City/St/Zip t; If A> Ay-t- r vA City/St/Zip 1, 1 Identification of Source j Phone#:_____ _ . Fax#: Collection Point/ A fi - I CA.CH.BI? L. Check#: Y Amounts._ I

BACTERIOLOGICAL ANALYSIS Lab#::- Lab#;_______________________ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS ^ _ Heterotrophic Plate Count ■" (hemodialysis & all others) _Trihalomethanes (524) __ Purgeabl.e Halocarbons (624/8260) iiAolatile Halocarbons (524) _ Purgeable Aromatics^ (624/8260) __ Coliform P/A (Public supplies) jA/olatile Aromajics (524) Acrolein^& Acrylonitrile ',(8.260)^ _ ■ __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all sam’ples) JY Total 'Trihalometh'ane Potential (510) Organbchlori'ne Pesticides ,(6087868’1) __ Microscopic __ •Microextractables,(50.4)^ _ RGB's’(Ar6chl6rs);(60878081)V Y' ' _^esticides/gC.^screen?'(508) .‘.^’'HerbicidesXSM18/663b,8j51)? t. ? _ Macroscopic _ API __ PCB a_s_Decachlorobiphenyl, (508A) ^;QthehPesficife;,(SMl8^630j' . " ' 1_ Other:■ ■ Herbicides, (515)) Petroleum’Hydrocafbdri Scan (310/13). ' ,_2 Pesticides (525)1 _ Glyc6is;in Water' . ’ •" Refrigerated? yes’’.:no __ Carbamate Pesticides (531) _ Acid.Extractablesr(625/8276)?/ , ' Chlorinated:?yes'___ no’’ __ Glyphosate (547) _ Base,Neutral'E)dractables; (625/8270)' ’ _ Diquat (549) J>^C/MS'’Unk’nowh’iScan' ' '•• Free Chlorine Res:mg/L 21 Chlorination Disinfection Byproducts (551) • Ph'&aiat&X60>ii’sX’> ■ ’/I. , * Total Chlorine Res;.mg/L .z^HaloaceticAcids (552) __ ’'.other:- Y ' .... . Other Pesticides (SMI 8/6630) pH ^UCMR Listi RADIOCHEMICAL ANALYSIS '_l MtBE Only (524) Radon •1 • __ Other______________________

INORGANIC ANALYSIS REQUESTED - Lab#; L A-/ __ Color _ Acidity ./^Aluminum - , ’ _ Potassium, • __ Turbidity __ Alkalinity jZAntimony ‘ ,• '■ "^■'•Selenium ■ _ pH' _ _ Bromide ’J<Srsenic' ' jl'Slver __ Conductivity __ Bromate/Chlorate/Chlorite . jZBarium _?Sodium __ Corrosivity (temp;_____ °C) _ Chloride ■Ikf^eiyllium •j^rThalliurn _ BOD (5 day) __ Cyanide Boron __ Vanadiurn __ Carbonaceous BOD (5 day)' Fluoride. i/Cadmiurn li^hc' _ Soluble BOD (5.day) ‘ __ Hardness, Total as^CaCOa Calaurh; as? CaCOa' _ Chemical Oxygen’Demahd _1 Nitrogen,.Ammonia as N _Oalciurn,' Cat^ " ' ,£LE) ■ ' ; Dissolved"Oxygen? ___ .Nitrogen? Nitrate^as^Nj _^hrpmiurTi; Total _ Mefals7CN) V'NitfogenlNiFrite'as'N f ^’Vojatilesf ' __ TotaTOrganic Carbon, Y_ Chromium;' Hexavalent; ,tj I

__ TotalOrganic Halides .^,lslitr6^; Totel KjeldahIJas N; ............ . •' SemiiViolatiles •__ Solids, Percent- (%)’. 6il iahd' Grease^ J Pesticides/RGB's ^^opper _• Solids, Settleable - j^rom ■__ Solibs, Suspended '. __ Xhospfiorus Total,as,Px ( (.^TGLP-Mefals'. _/ Sblt3s, Totaft Phosphorus; O'rtHoias P’ « __ ' Solibs.' Total Dissolved.' j>Mangariese! t^TGl^iP^eesticid^ ; -IjSolid^TotaL^latile? ’ L^Xgl^Hferfiicid^r _Surfactants, .^ercury/ ' i j/ofher:- . _Z^)olybclehum< , t.^.TGLR-V6latilest 5;^ickel‘ ’ ZfGLi?^NA’sl * ■J

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