Chain of Custody Record, Westchester County Dept of Labs

NYC 9/11 Public Portal Document paras ae we orge roe ra “Pty ENVIRONMENTAL SERVICES SAMPLE SUBMISSION: FORM ’ WESTCHESTER COUNTY LABORATORIES. AND RESEARCH © . 2 Dana Road, Valhalla, New York-10595 .* = , . whe ‘ (914) 231- 1620 Fax (914) 231- ia ye eo . 4 . a _NYS- ELAP No’ 10108. Time/Date Set: . a roy pe 2 ~ 2 Qi ip - ZS Ss ‘. Form A-70 (rey 0/01) : ; fon rr m_ woe re Sample Type (circle one): Bo, Q 2S: zy “Be , S25 . os CT Potable 3. Non Potable Treated 5 +s "Bottle #’s: ce {iF eR. OFS - ~U. 4913 iv: agi. 2. Non Potable 4. Other _ -Chain of Custody?,_— Ye eS _~_ No A ne ae A, Time/Date Collected: _ 2600 2-b6-e2 Comments: _ fa cere nes Collected By: LE er COT | Agency Code: PWS #: Source ID! __ _ Type Descriptor: _- Collected From: Bill to: ‘ “ Location’s/Individual’s Name Nyc Pe a) Name/Company street 11 Wes ile ve Dr Lit Street City/StZip__ eins lia . N s wSgy City/StZip identification of Source Phone#: : Faxt#: Collection Point Zt \ f % ft CA.CH, BI? Check: | Amount$ BACTERIOLOGICAL ANALYSIS Lab#: mo a Lab#: vt Heterotrophic Plate Count ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS” — (hemodialysis & all others) " —Jrihalomethanes (524) _ | _2.Purgéablé’Halocarbons (624/8260):* Coliform P/A (Public supplies) Volatile Halocarbons (524) . . <4s’Purgeable. Aromatics (624/8260):_ .. ~ ¥ “_ Coliform MPN (priv well, raw, stp) tMNVolatiie Aromatics (524) a ___ :Acrolein & Acrylonitrile (8260) . ‘ __ Fecal Coliform (all samples) _— Total Trihalomethane Potential (510) __Ofgahochlorine Pesticides, (6808/8081) . __ Microscopic , _ Microextractables (504) _. _..PCB's (Arochlots)” .(608/8081) ~~ Macroscopic ___ Pesticides/PCB screen (508) i __ Herbicides: (SM18/6630, 8151) : API . ___ PCB as Decachlorobiphenyl (508A) _ _- Other: Pésticides (SM18/6630) . “ __ Other: — Herbicides (515) _ | £_ Petroleum Hydrocarbon Scan’ ‘@t0- 13) ~~ ___ Pesticides (525) mo, —.Glyeols i in “Water - : Refrigerated? ____ yes ____no ___Carbamate Pesticides (531) - _. Acid Extractables . (625/8270) ar Chlorinated:? yes no __ Glyphosate ' (547) “Ls Base Neutral Extractables,: -(625/8270) xe Chiori — __Diquat (549) C/MS Unknown Scan me rege Te Free Chlorine Res:______ mg/L __ Chlorination Disinfection Byproduets" 8) _—_ Phthalates (606MS)" a ae Total Chlorine Res: ss mg/L ___ Haloacetic Acids (552) é noe - __ Other; ~ ae pH ‘ __ Other Pesticides (SM18/6630) ' . ; . To —_—_———— x __UCMR List 1 . a a as ~RADIOCHEMICAL ANALYSIS __ MtBE Only (524) pos |___ Radon . - ___ Other os = F INORGANIC ANALYSIS REQUESTED - Lab#: 5G a) , Se __ Color . __ Acidity - Y Aluminum ae Potassium) s+, _— Turbidity _— Alkalinity : Antimony . a ms elenium: - se __ pH __ Bromide \Zprsenic ok we Silver. ot _. Conductivity _— Bromate/Chlorate/Chlorite Barium ne ; = Sodium po __ Corrosivity (temp:___°C) __ Chloride . Beryllium |. .° : Thallium a ae __. BOD (5 day) _ Cyanide - Boron: ~ an fanadiuim » __ Carbonaceous BOD (5 day) _— Fluoride . ‘7Cadmium Lots a“ Zinc ya _ ~~ Soluble BOD (5 day) - - — Hardness, Total as CaCO3 __ Calcium, as CaCO3 5 ys, CLE? —————— —_— __. Chemical Oxygen Demand __ Nitrogen, Ammonia as N ' alcium, ‘Cat2 Ao, a Bec Metals ri CN . __ Dissolved Oxygen : __ Nitrogen, Nitrate as N . hromium, Total ; ra > = Mee __. Total Organic Carbon — Nitrogen; Nitrite as N hromium, Hexavalent... ‘ = Semi-violatiles; : “: __ Total Organic Halidés _— Nitrogen, Total Kjeldahl as N ‘Cobalt. ‘ * _ Pes des/PCBs an _.. Solids; Percent - (%) ‘ . Oil and Grease, r4 Copper me ae ; —. Solids, Settleable _ Phenol’. . i yon aan TELe. toN 1”. Solids; -Suspended : ; _ Phosphorus Total as'P* tea x oo TCL: Metals “1 Solids, Total . - —- Phosphorus,.Ortho'as P? sanesium Pt ae Ye — Teme open Solids, Total, Dissolved sSulfates - oy langafiese* . ICLP: Herpicid ides: alt, "~_ -§olids’ Total Volatile’ ma, Surfactarits: . Mercuty,. na i= " aw , ifOther Sey - Suvas4e Molybdenum? __ _,ACLB-Volatiiés; aw oh jhe NG FA a es he “= -TCEP-BNAS) | : i eee nee SESE _ a ts ee em : iA Nickel, a ee fi. : sot ‘ = = * ~~ ._. eee ~ et eee rae . 7 res = =~ ow ” 7 2 2 Sy Ca os ce tec a a. Set NYC- Wie, ‘000073434 2 oo . . *. PASE TIT Coca SN iad ad ee