Chain of Custody Record, Westchester County Dept of Labs

NYC 9/11 Public Portal Document

I MW? ^rn t t_£^ 2 Dana;Road, Valhalla,'New York 10595’

t Time/Date'Set: (914) 231-1620 Fax (914) 231-1772 ' NYS-E)/Ap No'; 10108 -Fop^-^,^rev/^/6^)^Y I'i' Sample Type (circle one): >1'. Potable'^ 3. Non Potable Treated Bottle #;s: — ■______ , •'A- - ------------ - . , : - ' ' ' ■ "T-

2.; Non PotaWe 4. Other Chain .of Custody?; Yes • No - ■. S'* * • 'Time/Date Collected: Comments: •i- Collected By: ~ Agency Code: PWS#:_______ _*Source ID: Type’ Descriptor: ,J1_ Collected From: Bill to: : . "'vi. Loca^tion’s/lndividual’s Name 0 - Name/Company Street (.A,/* / Z) «_______ Street';______ _ City/St/Zip I 2/4 A f(j s City/St/Zip Identification of Source 21 ' Phone#:______ ; Fax#: _____ c u______ /• . ’ -<■ / *

Collection Point _ hcA,CH,’BI? CtTeck#: Amount$l l

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:____________ ORGANIC POTABLE ANALYSIS ORGANIC NpNROTABLE/SOLID ANALYsIsA' __ Heterotrophic Plate Count __ Purgea^le Halocarbons (624/8260) -;’. (hemodialysis & all others) __ Trihalomethanes (524) __ Coliform P/A (Public supplies) ja^Volatile Halocarbons (524) __' Purgeab!eAramatics. (624/8260);.- '' " i ‘__ Coliform MPN (priv well, raw, stp) Volatile Aromatics (524) ^j5^§ijf^^orylohjWle, " •- ’ __ Fecal Coliform (all samples) __ Total Trih'alomethane Potential (510) __ ,brganochlorine.Pesticides;.(608/8081) a ___ Microscopic _L Microextractabies (504), __ Macroscopic __ Pesticides/pCBscreen' (508), i_ Herbicides (SMI8/6630'815,1) f _ PCB as':pecachl6r6l?rphenyl ’ (508A)’ _ Other pgsticicl'es- (SMi8/^630)-' "* ' — API :__ other': - Herbicides . (515)" / 2lYP'etfpleum'HydrbcarbpnS^n;^(310::13). Pesticides>(525)\ Glycbl^rh'Wafer- ' , * '• Refrigerated?yes no _Carbamate Pesticides, (531) Add Extractables,(625/8270)^,^ ~ Glyphosate. (M7)' Base;Neutral,ExtractabJes. (625/8270); ? Chlorinated:?yes no i ■ _ Diquat (549)' .tx'GC/MS Unknown Scan ‘ ' ' " ? - Free Chlorine Res:mg/L __ Chloririation Disinfection Byproducts (551) ' _ Phthalates" (606MS) ;• • ' . Total Chlorine Res:mg/L .__ Haloacetic Acids (552)' - Other: ... ---: a... __ Other Pesticides (SM18/6630) 1 1 pH - _ UCMR List 1 RADIOCHEMICAL ANALYSIS _ MtBE'Only (524) __ Radon __ Other______________________ - INORGANIC ANALYSIS REQUESTED - Lab#: rzzTZ^ Y ___ Color ■ _ Acidity JPfAlunriinum ■ __ Potassium • _ Turbidity _ Alkalinity • ' ^Antimony. - jxSelehium — pH __ Bromide' ' jx^rsenic • liver __ Conductivity __ Bromate/Chlorate/Chlorite XxBarium . ' Jli^iumA- ■’>? .. __ Corrosivity (temp:°C) _ Chloride XiZfieryllium .^ThaHium ’ . ■ ' _ BOD (5 day) __ Cyanide ■__ Boron -‘J_ Vahadiunri'-- __ Carbonaceous BOD (5 day) •__ Fluoride Jz^admium _ ,Soluble BOD (5 day) ‘_J Hardness,- Total as CaCOa __ Calcium, as.CaCQi, '~CL^ = ! __ Chemical,Oxygen Demand _ Nifrogen, Ammonia as'N .'i. Calcium; Ca*<' ;_jMetals/GN: ' fl' __ Dissolved .Oxygen _2 Nitrogen"Nitrate;as' N} j^^h'rbmwrp; Total • -,^,Voidtites” /■ Total Organic Carbon __ Nitrbg'en, Nitrite as N. __ Chromium/jH^aVaJent’ _ Total Organic Halides • _ Nitrogen;Tbtai’Kjeldahl as N.■' _5<Cobai6 ~ z_Semi-yiolatiles, Solids, Percent (%)’ JI Oil ariS^^Grease; ‘ . .1^ Pesticides(P'CB’sf^ . -LCdpper

h Solids; Settleable, “PhenoC ixlron.' __ Solids,’.Suspended _ CTqs^horus^TofeJ as P- 1 __ Rhosphoru^^ohhQas^P’ .IJTCLP-Mefel's/ Solids, Totab __ Magnesium; - i TGUe-Pesticides' Splids,Total, Dissolved! _ Suites? i*45langanjse) .__ Solidsi; Total Volatile; A^TCLPiiHer^ides; Surfacfarits; U TCLP^Vofatiles; •i ’V _.iuW) ' />’ M6lybdenum> • TGLP-BNAs! _ti<Nickei. • ' *■ »

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