Chain of Custody Record, Westchester County Dept of Labs

NYC 9/11 Public Portal Document

ENVIRONMENTXlZ^RVICES BXMPLElSUBMISSldN'^dRM. ’' ' " ster WESTCHESyER CbuNTY l^BQ^TORTES AND RESEARCH ' ivcom ' 2.Dana Road, Vaihalla; New York >10595 / 1 (914)231-1620’Fax (914) 231-1772 - . ’ ' ■ ' ' ' NYS-aXR.No. 10108'= ' Tirfie/bate Set:- ■ ' " . ' . ■ /Z’ 'F6rrTiA-70.^reV^p/01)' •

Sample Type (circle one): ’1. Potable. 3. Non Potable Treated Bottle #’s: /2^on Potable 4. Othe7^ _ Chain of Custody? Yes:___ . No;■ Time/Date Collected: Comments: ’ ______ Collected By: Agency Code: PWS#: • • Source ID: ■ TVpe ■ '■ Descriptor: ' ■ ■ - .-,7

Collected From: Bin to: Location’s/lndividual’s Name Name/Company 1 Street_________________ - Street______ ’ City/SVZip______________ City/St/Zip - Identification of Source Phone#:__________ Fax#:^ Collection Point CA.CH, Bl? Checkin: 2 Amounts

BACTERIOLOGICAL ANALYSIS ;L'ab#: tv Lab#:_____________________ _ ORGANIC POTABLE ANALYSIS . ORGANIC NONPOTAbLe/SOLiD ANALYSIS'' __ Heterotrophic Plate Count 2^Trihalomethanes (524) ■ ‘ (hemodialysis & all others) __ Purgeable.Halocarbons (624/8260) ’’ 'v_ Volatile Halocarbons (524) Purg^ble Aromatips , (624/8260) ■ __ Coliform P/A (Public supplies) __ Coliform MPN (priv well, raw, stp)_ _1 Volatile Aromatics (524) _ Acrolein &'Acrylonitrile (8260); ■ ' , - f Fecal Coliform (all samples) _ Total.Tri ha lomethane Potential (510) _'Organoch!orine Pesticides -(608/8081) _ ; Microextractables (504) _^' PCB’S ‘(Arochlors)' (608/808<j ' 2 . ■__ Microscopic ;_ Resticides/PCB screen (508) _ Herbicides (SMy8/663d,8l 51).' __ Macroscopic '22 RCB/as Decachlorobiphenyl (508A) ■. qther Pesticides (SN118/^0). : __ API ‘ - __ Other: _ ____________ ■ Herbiciilbs (515) _2 Petroleum Hydrocarbon Scan'(3^1071.3) ; _ Pesticides (525)^ .__ Glycois in.Water-. ‘ *' ' ( Y - • Refrigerated?yes no ’.2_Car6amate;Pesticides (531) _. Acid~Extractables) (625/8270) < /.^Glyphosate'. (547)' Base Neutral' Extractables,-(625/8270) , Chlorinated:?yes no .... ............... ’ '_.Diquaf-(549)' ;>^^C/MS..Llhknovyri,Scan.< Free Chlorine Res:mg/L' __ Chlorination Disinfection Byproducts (551) Phthalates (eOOMS)' . ' Total Chlorine Res:mg/L __ Haloacetic Acids' (552) __ ■•Other:.^_____________ ; _Other Pesticides (SMI8/6630) ' 1 ■ 4 * . pH ______________ _UCMRList1 ■ ■. : RADIOCHEMICAL ANALYSIS _ MtBE Orily (524) . - - • • • '----- • > - f. > *

__ Radon __ Other_______ ;_______________ ir:

INORGANIC ANALYSIS REQUESTED -.Lab#: ;_ . Color __ Aridity ' __ Aluminum _ _ Potassium __ Turbidity __ Alkalinity __ Antimony __ Selenium ■ __ pH Bromide , __ Arsenic Silver ■ __ Conductivity Bromate/Chlorate/Chlorite ^Barium __ Sodium ■ __ Corrosivity (temp:°C) __ Chloride __ Beryllium __ Thallium t_^ BOD (5 day), __ Cyanide __ Boron’ _1 Vanadium 1,^ Carbonaceous BOD (5,day) __ Fluoride' __ Cadmium — Zinc, _ Soluble. BOD, (5 day) Hardness, Total a^CaCOa ___Calcium, as CaCOa - : _ Chemical Oxygen Demand. __ Calcium; Ca*2' CLP • r __ , Nitrogen,. Ammonia as^N _Ch’rbmjum, Total < ,_:^.Metals/CN;- ) ' Dissolved Oxygen. __ Nitrogen,' Nitrate as.N Volatiles. 2 -‘21 Total. O'rganic.CarBon. _ Nitrogen,’ Nitrite as'’N' __ Chromium, Hexavalent JL‘Nitr6gen? Tc5tarkjeidah^ as N .'2_ Semi-violatile's. : _ Total'Organic .Halides? __ ^^.Cobalt _2,’P^.sticides/P’CBX J Sbiids; Rercfent' (%)' Oil ancl. Greasea ' __ Copper ' _ Solids) Settleabje,, —■Phenol ’ Iron ■j__ Solids, Suspended]. Phdsphojus)T6£al as.p-. >I£CE( _,Lead) i'. ) _ Sdlidslyfotail' 27, RHo'sphorus,:Ortho,as..P^ l^Magnesium:- ' _TeLe-Metals. ;_TGilR-Pe^icidesi ! _ Solids„Tota|;bjssolyec£l _ Sulfates ^nqanese- _ SdlidsiTpfal}\^iatile) __ Surf^clarifs) _Me'rcur^' f_.TCLP,-lfelali(es) 22 uy254.^ I » Other:; ' ---------- _74ol963enurh', p. TCLP^s) , __Nicl<ei)

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