Chain of Custody Record, Westchester County Dept of Labs

NYC 9/11 Public Portal Document

< ENVIRONMENTAL SERVICES SAMPLE'SUBMIsSoWdRIVlf^ rO^^^VOOm WESTCHESTER COUNTY LABOWORIESAND'KEI eA^^^ / ' - 2 Dana Road, Valhalla, New York 10595 ? g/OraWfM' ;• (914)231-1620 Fax (914) 231-1772 'V: vT-‘' NYS-ELAPNO.T0108, Time/Date Set:

Sample Type (circle one): ^5^otable 3. Non Potable Treated BoM-s: . - W 2. Non Potable 4. Other^ Chain of Custody? _^Yes'___ ’no'/ Time/Date Collected; // ___ Z-A.-O? Commients: Collected By: //< 5^ CP/J Agency Code: PWS #:________ ^•Source ID: , Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name _ NmZL Name/Company _ street t A W r' SI Lo f 7^ r \ , 1 C______ Str^fl________ City/St/Zip Vrj \XcU<~( K)\| I OS 9S City/St/Zip Identification of Source_________________________ Phone#:_______ Fax#: Collection Point. Ggo ________ CA,CH, Bl? tSjVeck#: Amounts

BACTERIOLOGICAL ANALYSIS Lab#: LafiJii:_________________ ORGANIC POTABLE ANALYSIS^ ORGANIC NONPOTABLE/SOLID ANALYSIS .. __ Heterotrophic Plate Count (hemodialysis & all others) __ Tjiihalomethanes (524) ,«.? . Purgeable Halocarbons (624/8260)' •. __ Coliform P/A (Public supplies) 4ZVolatile Halocarbons (524) riil^Purgeable Aromatics "•(624/8260) - ■'. __ Coliform MPN (priv well, raw, stp) Volatile Aromatics (524) , ziX Acrdleih & Acrylonitrile (8260) • ... __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) Xi'^iOrgahdchlorine Pesticides (608/8081) __ Microscopic __ Microextractables (504) 4 tSPCB’HAfdchlors) (608/8081 r < ■:. __ Pesticides/PCB screen (508) ’ ffe ' ,±:^h^'rbicides ('SM18/6636,8'l51),-.’ ' __ Macroscopic _ API __ PCB as Decachlorobiphenyl (508A) : j^.O?heffes«cides' (SM18/6630) ' '■ __ Other:_____________________ _ Herbicides (515) ; _J-Petroleijm Hydrocarbon Scan <(310-13) __ Pesticides (525) 1 Glycols in.Water ■ ' * Refrigerated?yes no __ Carbamate Pesticides (531) hr Z'Acid ExtractablesZ625/8270)'^ • , ■ ; __ Glyphosate (547) I^^se^Neuti^.Extractables‘(625/8279) 7? Chlorinated;?yes no __ Diquat (549) . . X w.v "iJd^C/MS Unknown Scan '/ Free Chlorine Res: . mg/L _Chlorination Disinfection Byproducts (551) X^Hhalates (606MS^ ' P.. < Total Chlorine Res: . rng/L __ Haloacetic Acids (552) ............................. ’X Other: , _other Pesticides (SMI8/6630) pH ___________ _UCMRList1 '.I RADIOCHEMICAL ANALYSIS _ MtBE OQly (524) ->1 __ Radon Other X/ 7 INORGANIC ANALYSIS REQUESTED - Lab#: __ Color __ Acidity X^luminum 'iX"' —yPotassium __ Turbidity __ Alkalinity ^ntimony . X^elenium - _ pH __ Bromide j:^rsenic . r, tXsilver’ __ Conductivity __ Bromate/Chlorate/Chlorite _<^arium .X?':;/' ■_iSodium __ Corrosivity (temp;. .’C) __ Chloride Beryllium '/A' XThallium< ' _ BOD (5 day) __ Cyanide -Thoron ' ••yanadiurn . __ Carbonaceous BOD (5 day) __ Fluoride jZCadmium ' > jXzinc ■ ■ _ Soluble BOD (5 day) __ Hardness. Total as CaCOa __ Calcium, as CaC03 ' __ Chemical Oxygen Demand __ Nitrogen. Ammonia as N __ Calcium, Ca+^ZX/Z' s ■CLE ? • __ Dissolved Oxygen _ Nitrogen.' Nitrate as N i/Chromium, TotaCh ‘ -_ Metals/CN, ' , 7?'

Total Organic Carbon •—Volatiles __ Nitrogen. Nitrite as N __ Chromium', Hekavafent 3-: >. _ZTotal Organic Halides. _Sembviolatiles; __ Nitrogen, Total Kjeldahl as N ■jZOobalt ■

_ Solids, Percent (%) \ . > ■__ Oil and Grease Pesticides/PCB’s , J^popper. _ Solids,-Settleable Solids', Suspended ■ . — Phenol __ phosphorus Total as P <Zjron ifi-X ■ i:_tCLP-Metals' - __ Solids; TotalV, __ -phosphorus. ^'Orthd as p _:_ Magnesium, __ ."Solids, Totai'Dissolved __ .Sulfates.,* _TCLR-Pesticides; j-^anganese.\' -i f '■_lTCLP;HZrb1cides. ‘ X^olids?,Total Volatile; __ Surfactants.. .’ii<>TCLPrVoiatil&'' ■' Dther: ■ X Molybdenum', v-* . , ’—■TCtP-BNA's'j .‘i f ■t r

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