Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

K'"* ’ ?■ WACCo^ >■ :

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ■’ J. ^tchester 11 v";^vcom WESTCHEStER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595' (914)231-1620 Fax (914) 231-1772 ;• - 7^-<- . 7 7,, 7/^' NYS-ELAPf No; 10108:^5 . Time/Date Set: /'Form A-70 (rev. 10/01) .,

:)A- Sample Type (circle one). i^Potable/ 3. Non Potable Treated Bottle #’s: ,7 .,.‘7 1

.2. Non Potable 4. Other_____________ Chain of Custody? Yes No ’ /?a it .Time/Date Collected: Comments: w; hi, Collected By: V Agency Code:’. PWS #: e - 7^ ' _ Source I p?_J Type Descriptor: H ■5

I' Collected From: Bill to: ■"t ' f," a * .a ,,!

F" k. Location’s/lndividual’s Name ‘■'street _________________________________________ NameVCompany ??

Street■ City/St/Zip_______ :____________________________ ' City/SV'Zip ■

if Identification of Source____________________________ Collection Point _______________ - Phone#: > It Y;'Fax#:t^ ^r-5-r

^ca.ch; Bi? i fi Z'Check#: ■*’" i'AmouhtS 1

I BACTERIOLOGICAL ANALYSIS L^b#: 7“ ——' - Y? y/rW/bllSSW'Sy, -yY J ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/^LID ANALYSIS / ' _L_ Heterotrophic Plate Count __ Trihalomethanes ‘ (524) ./ ■ Pur/able HaIocarbons (62'4/8260) ' ;'/. .,..' ; ’ (hemodialysis & all others)

I & _£■ Coliform P/A (Public supplies) _2'Coliform MPN (priv well, raw, stp) uL. Fecal Coliform (all samples)' __ Volatile Halocarbons (524) __ Volatile Aromatics (524) - ___Total Trihalomethane Potential (510) ’ ' _5; Purgeable Aromatics (624/8260)/ ( 7.7// ■ ?L_/A^®h'&7\ciyiohikHe?(8260)y/ 7?S7'/^^^^ •• __ .. Organochlonne Pesticides (608/8081) 7,-1'; _ Microextractables (504)' ' \ ’ Ifi PCB's (Ardchloi^b(606/8081)’’ _JMicroscopic _ Pesticides/PCB screen (508) / \ ? . '_7; Herbicides (SMI8/6630^8151)??/? __ Macroscopic __ PCB as Decachldrobiphenyl (508A) ’ 7’ >,■'_? Other Pesticides (SMI8/6630) .,. ‘ . 7*? — 'API " __ Herbicides (515) ' ' . / " 7- _7 - Pefrdleum Hydrocarbon,Scan - (310-.13) _■ Other: ________________________ __ Pesticides (525) '' ’*■' ..7^ - Refrigerated?,yes ho 1_ Carbamate Pesticides (531) . ? Jf * 7.777 Acid Extfactables (625/8270)./ ^Glyphosate (547) ■ ^.7" "?^?iB^a,h^utrarExtractabl^?(6^8^p/ 7- ...1 Chloririated:?yes no ’ __ Diquat (549) ' s ' x',/ _ ?

f Free Chlorine Res: Total Chlorine Res;________ mg/L T)H7.Q / ■ , mg/L

7. __ Chlorination Disinfection Byproducts .(55-1)' E/j' Phthalates (606MS') W _Haloacetic Acids'(552) _Other,Pesticides (SM18/6630) ' ............ iJ Other'_________ ' .7si ? 7-' ) ? " 7, t .

RADIOCHEMICAL ANALYSIS _UCMR ListT', _MtBE-Only_(524) ' y 7 i __RadOn Ji _ other

INOf^ANIC ANALYSIS REQUESTED ■ Lab#? • « ’i.Y A h/ r .i-Sf .YA '•T/ Color . , ; __ Acidity " », " \ ^Alurnihum*’''^’^ ?’* 7/-Turbidity , '__ Alkalinity < . ■ V Antimony 1 _ pH , __ Bromide . vZ-Arsehic b// i.C? *7 .Conductivity "__ Bromate/Chlo'rate/Chlorite , X.Barium 7; ... SodiurnYtf' - "y/

f; i '7_ Corrosivity (temp;°C)___ Chloride ; " .. Beryllium? / ’* ?/?Thalliurn?.'*« < _ BOD (5 day) . ’__ Cyanide ‘ 7.. r ___ Boron ' ■7; .<^7'/^-,..rr?r*’‘iXVana‘dlum ? £ ■ __ .7 Carbonaceous BOD (5 day) _ Soluble BOD-(5 day) , Chemical Oxygen Demand-■ __ Fluonde __ Hardness, Total as CaCOs __ Nitrogen, Ammonia as N XCadmium. ? 7 Calcium,, as CaCOa' .. ’.Calcium.Ca*^ ' jZ Zinc.' \

i-SLE 7?;/ .?■' /■i” '• '7 Dissolved Oxygeri - -■ * — Nitrogen, ‘Nitrate as N Y _7chroniium, Tota| 7f ?. a^ ;■ Y ZX'Meials/CN':,/?^ I? __ Total Organic Carbon '__ Nitrogen, Nitrite as N , . •___ ^Chromium,' Hexavalerit * , ■ ;£j-yolatiles7?'? ?

I” : _ Total Organic Halides _1 Nitrogen, Total kjeldahl as N Cobalt ? ■YY Semi-violatiles LhPe&icide^PCB’si’ ‘ >3^.i J , .;..i

E __ Solids, Percient (%) Solids. Settieable ‘__ Oil and Grease __ Phenol' -- ? ' v Copper ’2 lrori . '■ % ■___ Solids, Suspended __ Phosphorus Total as P ’ ’jZ Lead? * LiTCLP-Metals ■ . . _ Solids, Total ? .__ Phosphorus, Ortho as P; __ ^.Magnesium / r __ Sulfates ;• /^Manganese ■? TCLP-Pesticides _ Solids, Total Dissolved __ 'Surfactants ^Mercury _TCLP-Herbicides __ -Solids, Total Volatile _^ 'TCLP-Voiatiles < i other: ., _ UV254 CriMolybdenum ' __ TCLP-BNAs -h. ’ J T ;■ V Nickel ' ,7 .7 A' J ■7i//7L7...,C.y .fa..-si

NYC-WTC_000073897