Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document 2 i

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM L ^W'estuiGster WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 105952 (2'2;^ ' / " 2 £

(914)231-1620 Fax (914) 231-1772 K y T' ./T. ■ 1 NYS-ELAP No. 10108 ’ Time/Date Set: t-tk Sarngle Type (circle one): Bottle #’s: k Form A-70 (rev. 10/01 ) jj

-2 B 3. Non Potable Treated

k 2. Non Potable Time/Date Collected: Collected By: 4. Other'____________

Agency Code: Chain of Custody? _32.>Yes 321 No Comments: ' 2 ‘ - 'k, PWS #: 2 2 J source ID: ..-Tk, ' .. >r

Type Descriptor: Collected From: Bill to: ' L -iT' ‘ '■ ■ t > Location’s/individual’s Name ' '"' Name/Company _2 h " Street _________ _2__ Street ' -’’v 2' ’

City/St/Zip - City/St/Zip Identification of Source Phone#:' 2 ’T"'- .2.' Fax#: V-

Collection. Point_____ _________ CA,CH, Bl? • .^j22;Check#2.kj2 22 ,Amount$

I ■J

BACTERIOLOGICAL ANALYSIS Lab#: Lab#:'___J^ _____________ __ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS 1 •__ Heterotrophic Plate Count .■ JJ-Puit|dable j-laioc^^hsk(624/826()) 2.,2' (hemodialysis & all others) _Trihalomethanes (524) __ Volatile Halocarbons (524) -L_2P.u^eable Arorhatics26247826p)2j J J T I __ Coliform P/A (Public supplies) Coliform MPN (priv well, raw, stp) __ "Volatile Aromatics (524) Y2/j;;?ACTdlein'&;^crylonitfilek(8260) Total Trihalomethane Potential (510) .j_26rganochlorine pesticides (608/8(581) • I- __ Fecal,Coliform (all samples)

r __ Microscopic __Macroscopic — API 2 _ Other: _ __________________ . ‘ , __ Mic’roextractables (504) ’ - __ Pesticides/PCB screen (508) __ PCB as Decachlorobiphenyl (5b8A) _ Herbicides (515) - ? ■^'2L4PCB^'^rdchldrsV(608/808lj’ 2 , 2,_Tn'Hefbiciclds2sMl8/663p,8151j P^Scidesk‘(SM 18/6630)' 22^;Petr6leumTlydrbdarbbn,Scbnk(310-13) ' 2 22- j ' /

• __ : Pesticides (525) 5 - ’ i/Mlycols' in Water "" j' - ' • Refrigerated?yes no _ Carbamate Pesticides (531) .Y:22 Y/&iolkExtractablesy(625/827d) 1 ■ /k. ■- .,r - *' Chlorinated:? yes no __ Glyphosate (547) ' 5.^«Ba^;'NOutrarExtracteblesl4fe25/82^ _ T- Free Chlorine Res;mg/L Total Chlorine Res: " mg/L __ Diquat (549) __ Chlorination Disinfection Byproducts (551)' .. ’ljk(3C/MS Unknown Scan “ /k ’ ^±'„Phthalates2666MSr' ■ . , "• J L.

__ Haloacetic Acids (552) r- £2. bther:2^JjLjlJL__lJ_k:2<jk-k. I _ Other Pesticides' (SM18/6630) ? _;UCMRList1 -■ k !, *, RADIOCHEMICAL ANALYSIS _ MtBE Only (524) ' 2T' ' ■ : _ SRadon ■ , / :k .;j'?k.k/k

f.f- __ Other __ ___________________ - ■ )

INORGANIC ANALYSIS REQUESTED - Lab#: 2 ; "v-' k '22 f2-''W t-C'l 1

i. Color; ' 2_‘Turbidity — pH.22.:* 2; ’ , ,

• -? _ Acidity ■ , ' __ 'Alkalinity. Bromide" ' ’ , j/.Aluminum 4 . k? '2 > V Antimony '' \ 2’ ' ’ ; 2^Arsenic' 222. , ' "" . '■ .22Potassium-; ’^/YsSeleniumJ ' •, ’'22 Silver^. 'I: . J'’ '

_ Conductivity _'Br6mate/Chlorate/Chl6rite ’ k^Barium . < . , ... ;_ Sodium 2 k I ■ T। •

rSk 1 J. Corrosivity (temp:. .’C) Chloride , - ‘ '■L^Beryllium. *. 2 " '^Trailium.;| ; k ... ' _ BOD (5 day)- . __ Cyanide . , <_ Borort'’ ' 2 '2 :_2\/^hadiurri ' - k; 4 _ Carbonaceous BOD (5 day) __ Fluoride ' k." _Cadmium_ k _j Soluble BOD (5 day) < - Hardness, Total as CaCOs ._ Calcium, as CaCOT''

r. 2__Chemical Oxygen Demand ’ _2 Nitrogen, Ammonia as N. ^Calcium, Ca*2 Y>- , CLP . *’ ■- • ;l

Dissolved Oxygen ' _i_ Total Organic Carbon - __ Nitrogen, Nitrate as N * ’ __ Nitrogen, Nitrite as N • 22Chromium, Total„. k- __ Chromium, Hexavalent ’32 Metals/CNV • " ,_y Volatiles 2; i -_i_ Semi-violatiles' •* ; ' -Total Organic Halides __ Nitrogen,.Total Kjeldahl as N .2i4Cobalt , "• ‘.2 ■ -'1

__ Solids, Percent (%) ,, __ :■ Oil and Grease 2; Pesticides/PCB’s j^Copper. ' 'k, J_ Solids;'Settleable . __ Phenol ■ '-/iron k ■/ 2 ,. !

I __ Solids, Suspended __ Solids, Total, ‘ __ Phosphorus Total as P-. ■ __ -Phosphorus, Ortho as P ' .^/Lead __ Magnesium * „k2; -, ' TCLP . . .k, /STCLF^Metal^ ' k - '-r k_^ tCLP-Pesticides 4 • , ■ ,

r _ Solids, Total Dissolved _ Sulfates V Manganese', _y Solids, Total Volatile __ Surfactants ' _TTCLP-Hefbicides ‘ ; - _Y:Mefcury /k ; 'l Other: __. TCLP-Volatiles r ' ' ’ " _ UV254 , J2.Molybdenum. 2 Jr Nickel ,, 2,, lx TCLP-BNA's I ' 1 1.14:^ J? '2;.

NYC-WTC_000073896