Chain of Custody Record, Westchester County Dept of Labs

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ENVIRONMENTAL^SERVXCESiSAMPeE SUBMISSION rdRM’" I ter . VyESfCHESTER‘(:OUNfYLABQRATORIES^ANb'RESEARCH^ :comi 2 Danaj Road,’Valhalla, New York 10595) 5 (914) 231-1620 Tax (914) 231,1772. ' . ' " ^Y%,ELA5'No.)1p'l08> • 'Time/Date Set:'- ________________ _________ p:^ 2rjb Form'A-70 (rew10/01);

Sample Type (circle one): Q-2^1 «- (l^otable 3. Non Potable Treated Bottle #'s: 2. Non Potable 4. Other____________ Chain of Custody? .Yes,_:--.Nd', Time/Date Collected: ■ / ! ■ Comments: ■ Collected By: L. Agency Code: PWS #: ________ Source ID: * ' ' 'Type Descriptor:, Collected From: Bill to: V' Location’s/lndividual's Name M y C. IXT Name/Company Street _ >9 bf-<vc____ Street__________ City/St/Zip 1/f) t hfi Uct City/St/Zip Identification of Source____________________________ Phone#:________ Fax#: Collection Point. Ago Gm_________ CA.CH, Bl? . Check#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#:___________________________ Lab#:________________________ I ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS ^ __ Heterotrophic Plate Count (hemodialysis & all others) __ Trihalomethanes (524) _ Purgeable Halocarbons '(624/8266)/ • LZ\/olatile Halocarbons (524) __ Purg'eable.Aromatics (624/8260) __ • Coliform P/A (Public supplies) _t^olatile Aromatics. (524)' _■ Acrolein & Abrylohitrile j jSZeO): ’ __ Coliform MPN. (priywell, raw, sip)'' __ FecaJ Coliform (all samples) __ Total Trihalpmethane Potential (510) __ Orgahdchlorine Pesticides'’ (668/8O8'1’)X ' __ Microscopic .__ Microextractables’ (504)' _ ;PC^ (Arochl6rs)^.^68ZBb81)‘ '' * \ __ Macroscopic i __ Pesticides/PCB/screen (508) J_.-Herbicides(SMi6/6636;8j5JL)h.;^ _^'API __ .PCB.as'Decachlorobiphenyi; (508A) Other Pesticides (SMI8/66'30). < " __ ; Other: ' - - - - I Herbicides-(515)' Y. Petroleum Hydrocarbon Scan ' (^1 Ori 3)^ Pesticides'(525)’ __ ■iGlycols'in Water?”; Y Refrigerated?yes no. ,__ Carbamate Pesticides (531) ._,vAcid^racta^s. (625/8270). J Chlorinated:? yes.;:i.noj i _ GlypHosateH547) 1_ Base.iyeutrafEidfacte (62^8270)? l^Diquat (549)^ Xii<fec?MS^Uril<npwn^Gcan ’5. *>' . Free Chlorine Res: ■ — mg/L-, __ Chlorination Disinfection Byproducts (551)' _1 Phthalates (606^3) •.;> \1- Total Chlorine Res:mg/L _ Haloacetic Acids' (552) ' J_ Other: - ' . _Other Pesticides (SMI8/6630) . ....... ’ pH _UCMRList1 -• RADIOCHEMICAL ANALYSIS _ MtBE Onjy (524) “T--------- 73—:-------------------- __ Radon _ Other______________________

INQRGANIC ANALYSIS REQUESTED - Lab#: __ Color __ /Acidity , □ifAJpminum . .-^-•^assium. _ Turbidity __ Alkalinity _t»Kntimony , j>Seleniurn‘ _ pH __ Bromide jZ^senic ,-^ilver ' __ Conductivity __ Brdmate/Chlorate/Chlorite . _i£:^rium _Sodiurh' ■__ Corrosivity (temp;______ °C) __ Chloride _±*fBeryl!ium ’ .j^fThallium. " _BOD(5'day) __ Cyanide Boron . _\anadium'.' __ Carbonaceous BOD (5 day)' __ Fluoride _j><5admium ' , _ Soluble BOD (5 day) _ Hardness, Total as CaCOa ■ _ tCalcium, as' CaCOs; :__ Chemical Oxygen Demand • _ Nitrogen, Ammopia as n’ _ Calcium,’ Ca*2l “__ Dissoive'd Oxygen ;__l\^taf^N. _ Nitrogen,;Nitrate'as,N fc^^^Jhrom'i urn,'Total.' _ _ Total'Organic,Carbon __ cTirorhium,'Hexavalent' __.Volatiles;, _Y‘Nitrogen, Nitrite as N- SemiTViolatilesj > _ Total'Organic Halides _lyitipg§n,T6Ml9jBl.dafil asN' Li^balt. t^_Pisticidis/PCBjs.i __ Solids, Percent' (%)V _1.^0irand G’rease.' 5^ _ Solids>SettleaBle' Phenol ’ " Solids,' Suspended,! _ Ph6sph6rus).T6jal as P’ ;I£L£- J' Solids, Total »- _TGlp^®etars.' __ Rh"osphonjs^Oftho;as.R7 __ Magriesium; Solids, Jofal Dissolved} 7^, Sulfates! jj^^wn^gahesej ; JGL^Testicides. .„,;_^,S6lidS;,TdtahVolatile) Surfa'ctants. j^lWe'rciTry, -tLTGLB-Harbicfdes; (■

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