Chain of Custody Record, Westchester County Dept of Labs

NYC 9/11 Public Portal Document •5^ nA. V— 4 t

ENVIRONMENTALSERVICESSAMRLBSUBMISSIONFbRMi WEStCHESTER:COUNTy*lJ^B6r^TORIE^^^ ANP^ESE^Kc'K . 2 Dana Road,.Valhalla, New York ,10595V’'^ '? -. ‘ - (914)231-1620 Fax (914) 231-1772 r. , . zs. • “■ ' NVS-ELAP No^ioips,^^ Time/Date Set: ■ Form A-70XreyJ0/Qi2/”

Sample Type (circle one): Quotable' 3. Non Potable Treated Bottle #'s; 2. Non^Potable 4. Other Chain of Cus'tbdv? ^ "^7Yes Nd Time/Date Collected: - .- H 0 Comments; . . .............. Collected By: L. • Agency Code:; PWS #:zirTtSource ID: - ' Type Descriptor: Bill to: ' Collected From: Location's/individuai’s Name K) T>r- P Name/Company • " ■ -_________- __________ _ Street _____ Street-j’ . - ■ - .

City/St/Zip y/fi I , fO y IO S9S City/SVZip ‘

Identification of Source______________________________ Phone#: Fax#: Collection Point. pfc I __________ I CA.CH, Bl? /aS-. Check#: Amounts- ■

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:___________________________ ORGANIC POTABLE ANALYSIS ORGANIC NpNPOTABLE/SOLID ANALYSIS __ Heterotrophic Plate Count Ji^.PurSeable;Halocarbons. (624/8260) __ Trihalomethanes (524) (hemodialysis & all others) t>^j3latile Halocarbons (524) liEt^-Purge^je^romatics .1(624/8260) - " __ Coliform P/A (Public supplies) _^fvolatile Aromatics (524). i^T^Acrolerh.A^Acryionitrile' (8260). __ Coliform MPN (priv well, raw. stp) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) prganochlorine.Pesticides: (60878081) __ Microextractables (504), ■ 2^ rcB>;i(Arbchl^)'(6(^081) ''' ’ __ Microscopic '__ Pesticides/PCB screen (508) .'3S'Herbicides:(SM1876630,8151).', ,7 __ Macroscopic _ API __ PCB as Decachlorobiphenyl (508A)' .^■.‘OTherPesticife __ Other: _______ ■_ _ Herbicides (515) lXl.PetrOleoffi'FiydrocaH3bh (310-13)' _ Pesticides (525) .ii. Glycols in Water.; Refrigerated?yes no __ Carbamate Pesticides (531) □LVAcid Extractables (625/8270) __ Glyphosate (547) <.-^se Neutral'&<tracta^^(625/8270 . , , Chlorinated:?"yes no __ Diquat (549) ■&^GG/MS"Tinknown Scan ' 'Free Chlorine Res: . mg/L iS;Phthalafes’(6'06MS)> ■ ’ __ Chlorination Disinfection Byproducts (551) Total Chlorine Res: - nig/L , __ _Haloacetic Acids (552) ^Sthen-”- ' ■ . • _Other Pesticides (SMI8/6630) pH _____________ f _UCMRList X RADIOCHEMICAL ANALYSIS _MtBE 6'nly (524) ___ Radon __ Other_______________________

INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Aridity ’ £1 Aluminurn' __2^tassium' __ Turbidity • _ Alkalinity'■■ .ix^Antimbny ■ _±^lenium _ pH __ Bromide ji>^rsenic J?;^lver' __ Conductivity __ Bromate/Chlorate/Chlorite. iS^arium “'.V- , __.Sodium' __ Corrosivity (temp:°C) __ Chloride j^^*Beryllium ■ >^hal!ium< ■ BOD (5 day) __ Cyanide __ Boron. ‘ V' _.\fanbdiuiB __ Carbonaceous BOD (5 day) __ Fludride j.x^admium _ Soluble BOD (5’day) ■ Hardness, Total as CaCOs _ Calcium, as CaCjOi-,;,? Chemical Oxygen Demand' ^ Nitrogen,;Ammonia as N Calcium,;Ca*2'^ ' jCLE j^xdhromium; Totbl77 ' ’ _ ’^Metals/CN •_ Dissolved Oxygen __ Nitrogen^Nitrate.as N । • Vofatiies _ Total Organic^Carbon _ Nitrogen; Nitrite; as N __ Chromium, Hexayalent '1 1 _T Total Qfganic Halides. _^Nitfogeri, Total.'Kjeldahl a.s NJ j^d.balt; _ Semi-violatiles- _ Sblids'LPer^n^(^)^ ^"^dirarid Grease.^ ^‘P'esticides/pCB's- ^^bppef: ;i £; *•. I__ Solids,<Settleable'' PhenoL TCLP: 5 ,__ ."7 Solids; Suspended Phosphofusjotapas. 9.'. JzdCead) I _TCLR-Metals Solids,.Total' Phosphorus,"Ortho as'P- _::_.Magnesi'um fcOp-Resticidesj ! - sblids'i.Total .Dissolved < .^ Sulfates"' ’ J<^hganeSe> •J ' XTCLI=-Heffeicides) Surfactants* "vMercury/ I- .L’TeLP-Vblbtilesj _.U.V254; JrlVotybdenum'.. TCCl^BKi^’s, jMNickeit - .J , .

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