Chain of Custody Record, Westchester County Dept of Labs

NYC 9/11 Public Portal Document •*

ENVIRONMENTAL SERVICES SAMPLE'SUBMISSION >J tester A WESTCHESTER COUNTY LABOI^ORIES^i^|?ES^RCri / rovcom 2 Dana Road, Valhalla, New York 10595'i: •A (914)^231-1620 Fax (914) 231-1772 , /r *LM.JWBUAid» ■ ; Y JNYS-ELAPNo;l0108' Time/Date Set:

Sample Type (circle one); ■ . - ' /^pPotable 3. Non Potable Treated • Bottle #’s: Y'"-1MfeS"'ii<^f A ■-rrsS Y-tZ-Q'??, ^2. Non Potable 4. Other Chain of Custody? _Ji’,Yes'_Li_L No Time/Date Collected; _ Collected By: A- > ^^8/7 Agency Code: Comments; PWS #; Source ID: ' * Type Descriptor: J

Collected From: Bill to: ?■ < ' • Location's/lndividual’s Name P Name/Company-. Street i 0r> f_________ Street________ City/SVZip \J^ I h O UO Ny ) Q 5, 9 ‘s" City/St/Zip Identification of Source______________________________ Phone#: Fax#: Collection Point D C i Pi___________________ __ CA.CH, Bl? Check'#: . Amdunt$2^

BACTERIOLOGICAL ANALYSIS Lab#: Lab#; _______________________ ORGANIC NONPOTABLE/SbUD ANALYSIS ORGANIC POTABLE ANALYSIS ‘ __ Heterotrophic Plate Count __ Trihalomethanes (524) _ .Purgeable‘Halocarbons '(624/8260)’ ’ ■ (hemodialysis & all others) .iZVolatile Halocarbons (524) -.X;' Purgeable Aromatics (624/8260) , ' .^ Coliform P/A (Public supplies) _£z^olatile Aromatics ,,(524) ’ iX;'Acrolein & Acrylonitrile (8260) ' ■ i 'Coliform MPN (priv well, raw, stp) __ Total, Trihalomethane Potential (510) ■ X Qrgaripchlorine Pesticidee'(608/8081) '■ > ; I f_Y ^ecaLColiform .(all samples) X* PCB’s^Afdchlofs) ;,(60878081) '__ Microextractables (5b4)’ * f '.Microscopic -_2 Re^icides/PCB^screen (508) < ■iX?Herbicides (S'M)i8/6630,8l51) ' ’-A • (X l^ac'roscopic __ RGB as,.Decachlorobiphehy|i (508A), ,^;Om'erP^sfidd^: (SMi8/663p) > ' UZaW' Herbicides-(515) XfRetroleurh Hydrocarbon Scan (310-13) )_^Other;._________ ________ _2 pesticides ■ (525) . •iXeiycdls in 'Water ,/ 'Refrigerated?yes ___ no J_ Carbamate Pesticides t(531) -XAAcid ExJractables (625/8270) ■. ’ __ Glyphosate (547) . Ghlorihated:?yes___ no •i^f^C/MS'UhknowhS'can''’ , __ Diquat (549) .FreXChlorine Res;________ mg/L __ Chlorination Disinfection Byproducts (551 ) i' .£XPtithal^e^l(6(36Di^) ' Y ' ' Y * iToiarChlorine Res;mg/L __ Haloacetic Acids (552) Others-Z ? ■ ■ ■________ Y- ■ _Other Pesticides (SMI8/6630) _ UCMR List 1 V " RADIOCHEMICAL ANALYSIS _ MtBE Only (524) ■

■ i “Other____________________ 'SZZSZZl f INORGANIC ANALYSIS REQUESTED - Lab#: ' • , , J- • ' ' -J — Acidity X Aluminum _ .-.Potassium, ';..d,>Zeleniurh- . ) S ■ |: Turbidity -rr, Alkalinity’ , =„ , j/Antimony v —?Bromide> ' ji^rsenic . .Conductivity __ Bromate/Chldrate/Chlorite jZBarium fX-§pdium:; ; , Corrosivity' (temp:°C) — Chloride, j^Bdyllium ■> aZThaliium; " ' _ Cyanide _ Boron;, ^fenadjum • W^<J?y). ____ Gar&onacebus BOD (5 day) __ Flubride; _v^admium' ii- , f jZzinc .1 ■ ' - ■ - . I X SolujSIe BOp) (5 day) ' _ Hardne^^ofal as CaCps). X’)Carciurh;.aspafeCbj — ■. •• <

l-L'CharttltatiOxygen Demand _ Nitroger^^nifnbnia as N ' ‘_ . Calcium; Ca«4"*'\ ’ X.Metals/CN kWIK • ’ , XiNi.trogen; Nitrate as N; ■ ^.NitrogenDNitrite as N ’ YYCRrbrriiumj totaix' * ' ” (tomium- Xekav^ieritS. t . 'X Volatiles, Nitrogen)-Total.Kjeldafil aslNl JZ^o^alt; X* ' ? • * ._SenliViolatiles„^ •' Y J ^^.OilWxGjease.’ j^^opRer ' - ; > •_-Pestici ’d es7PCB.’s.. J^ipnV ; ” SjJsj^dwlt ^:<ehos^brys,1b4al as p; . ^XLead ’Y r •/ ' .x_ M|gp‘?siumr ' - > ■.. ilK 'SotldS! TofeLDIssolyej^ "--TCLR-HeZc'des , y 1/; Efe"' i 5.. T- I

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