Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document \ - ./-i ,,................. ft.-'- -.ft. -

y; , ■ - Y- ■' . -VT '■ ' = '■ <Y . h ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ' vf *=^0. nrv^BoVCOm WESTCHESTER COUNTY LABORATORIES AND RESEARCH ’ ■- ... . 2 Dana Road, Valhalla,’New York *10595 - " j/fl ' (914)231-1620 Fax (914) 231-1'772 I ■ ' • ■ ‘ ... - ■ NYS-ELAF^No. 10108 '-5 Time/Date Set: . Form7V70Vev.'l 0/01)

Sample Type (circle one): ■ ,1. Potable 3. Non Potable Treated iC , Chain of Custody? ^v^'Yes L_ ^'No & 2. Non Potable 4. Other ■ . .J-" Time/Date Collected: _ Comments; " '' ■■■* Collected By: I /fV?-Agency Code; kt-VV Lv PWS #: _ Source ID: Type Descriptor:

r: /Collected From:- „ Location's/lndividual’s Name" Bill to: ■:

Name/Cdmpany T.-'-

li- ■!

6 Street __ Street ______ ■ i

, City/St/Zip-______________ L City/St/Zip ■ Identification of Source Phone#:_____ _L "Collection Point CA,CH, Bl? VVL Check#:', ' Amounts ■

fc BACTERIOLOGICAL ANALYSIS Lab#: __ ________________________ __ ■ Heterotrophic Plate Count (hemodialysis & all others) Lab#: _

ORGANIC POTABLE ANALYSIS _'Trihalomethanes' (524) ORGANIC NONPOTABLE/SOLID ANALYSIS •_2' Purgeable Halobarbons :(624/826by Y 5 J

I __ Volatile Halocarbons (524) J JL Purgeable AVomatics .(624/8260) :, Z_ Coliforrn P/A (Public supplies) __ Volatile Aromatics (524) YX’’ Ac’rolein'8/'Aci5donitrileH8260)V __ Coliform MPN (priv well, raw, stp) ^iJiOrganbchlofine (pesticides* (608/808'i) , 4 Y .1

s :__ Fecal^Coliform (all samples) '__ Total Trihalomethane,Potential (510) i ; Microextractables (504) VYl>PCB’s’(Ardchl6rsf (608/8081)\ Y\ ' Microscopic „ __ Pesticides/PCB screen (508) _L;’Herbicides (SM18/6630,8j5T) “ . ’1 Y ’__ Macroscopic _.AP1 ' __ PCB as Decachlorobiphenyl (508A) ' YjiOther Pesticides/ (SM18/6630) 1 , iJ __ Herbicides (515) * - ^ ’ Petroleum Hydrocarbon''Scah (3'10-13)' _::;-Other:; Pesticides (525): - ' ... '' Vi’Giycols'in,Water’-, ' ■?*"'>-7 V " S 5 Refrigerated? yes no ' _ Carbamate Pesticides (531) l_vAcid Extractables; (625/8270)' 4" ? ._2‘Glyphosate (547) , ' Y4 Base Neutral Extractables ; (625/8270) Chlorinated:? yes no __ Diquat (549) ■ v^GC/MS Unknown’Scan ’ Y Y >Y Free Chlorine Res:' mg/L '_Y/Phthalates (606MS) ft i- Total Chlorine Res:■ ' mg/L - Chlorination’Disinfection Byproducts (551) •' Haloacetic Acids (552) _Other'Pesticides (SMI8/6630) _Y." Other: 4

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ftT .RADIOCHEMICAL ANALYSIS .Radon. J_ MtBE Only (524) € .-I-

__ other Y. ■^4 INORGANIC ANALYSIS REQUESTED - Lab#: ' Color _L Turbidity pH. __ jflcidity __ Alkalinity _ Bromide . < __ Aluminum __ Antim'ony __ Arsenic ''"z. ’ ^’Potassium .X-’Selehium 'Xc-Silyer^ . ' I __ 1 Conductivity '__ Bromate/Chlorate/Chlorite __ Barium ' Sodium I- i ?' __ Corrosivity (temp:. °C) '__ Chloride __ Beryllium Thallium'^ v ' BOD (5 day) __ Cyanide __ Boron ■ ■vV" _ _£ Vanadium^ ,; I __ Carbonaceous BOD (5 day) __ Fluoride __ Cadrnium MX/’ / "tLi Zinc’’"''’ i -y _/Soluble BOD (5 day) 1 Kr __ Hardness, Total as CaCOs __ Calcium, as CaCOa; > CL£- . a “ w- __ Chemical Oxygen Demand __L Nitrogen, Ammonia as N __ Calcium, Ca*2 ■ .■ r -•

s 1 Metals/CN', ■ ■ ■;i' 1! V__ Dissolved Oxygen Nitrogen, Nitrate'as N ' __ Chromium, Total ' • Volatiles' ’ CS' Total Organic Carbon __ Nitrogen, Nitrite as N __ Chromium, Hexavalent ■--'Semi-violatiles S' __ Total Organic Halides __ Nitrogen, Total Kjeldahl as N __ Cobalt Pesticides/PCB’s ' _ Solids,'Percent (%) __ Oil and Grease Copper :! __ Solids, Settleable __ Phenol _ Iron / Y-' •‘'5 ' __ Solids, Suspended __ 'Solids, Total __ Phosphorus Total as P __ Phosphorus; Ortho as P ‘ __ Lead __ Magnesium' _TGLP-Metals .jg. 4 I __ TCLP-Pesticides' ' • __ Solids, Total Dissolved __ Sulfates' __ Manganese -i- _ Solids, Total Volatile' __ Surfactants _ Mercury ■_TCLP-Herbicides' 1 I'/ ■_ TCLR-Volatiles, ? _ Other:____________________ _ UV254 __ Molybdenum ; _ TCLP^NA’s , ‘ ■ 1 __ Nickel 1

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