Chain of Custody Record, Westchester County Lab, Mar 2002

NYC 9/11 Public Portal Document

P- ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM _ tS xeeoA WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla. New York 10595 sri I ft (914)231-1620 Fax (914) 231-1772 NYS-ELAP No. 10108 ’ F Time/Date Set: FormA-70(reY10ffl1)j I- I Sample Type (cirda one): F 1 ft Iy 1, Potable 2. Non Potable Time/Date Collected: Collected By: d-iidMZ 3. Non Potable Treated 4. Other Bottlers: Chain of Custody? Comments: PWSifc Yes _ No

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Agency Code: Source ID: .Type Descriptor. — Collected From: Location’s/lndividual’sName O0': Name/Company .-•S' '

Street.________________ __ Street Citv/Stglp Clty/Srap__ K. ’ Identification of Source _____ Phone#: I Gofl Point ________ fpE "chSTZZ—— BACTERIOLOGICAL ANALYSIS Lab#: _________________ Lab#:' - ft "O ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOUD ANALYSIS / —^ Heterotrophic Plate Count _TrihaIomethanes{524) __ Purgeable Halocarbons (624/8260) J,? {h8modia^is& all others) S'- iX. Ct^WtW’T’WA (PuMc supplies) _ .Volatile Halocarbons(524) ;;'Ji;,.Purgeabfem^t(^:^)rz7,s^|| t"'' __ Coliform MPN (priv well, raw, stp) _ Volatile Aromatics (524) __ Acroteiha Acrylonitrile (8280) ' _ Total Trihalomethane Potential (510) „ — Organochiorine Ffes^s(808/8081}g:<; i_ Fecai Collform (all samples)

F' fe Microscopic _ Macroscopic WAPI : ;__Microextractables (504) __ Pestlddes/PCB screen (508) _ PCB as Decachlorobiphenyl (508A) _ Herbicides (515) __ other Pestiddes ($M18«830) < __ Petroleum Hydrocarbon Scan (310-13), .r ^ ------------—---------- _ Pesticides: (525) - Refrigerated? yes no _ Carbamate Pesticides (531)

I1^' Chlortn««J:7----- prop Chlorine Res:_____ mg/L Qhkxrine Res: mg/L __ Glyphosate (547) _iOiquat (549) __ Chlorination Disinfection Byproducts (551) _ Hatoacetlc Adds (552) Base Neutral Extractabl^ (625/8270)

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■■77 E..pft'L-______ . _ Other Pesticides (SMI8/6630) ^UCMRUstl ^RADIOCHEMICAL ANAlYSiS _MtBE Only (524) ■-•.A

— Other __________

f INORGANIC ANALYSIS REQUESTED - Lab#: Ccilof ■ __ /scldity _Alumlnum Turbidity - AikaHnIty __ Antimony •pH :? —firwt^.':........................ Conductivity .... _Bromate/Chlorate/Chlorite

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r Corrosivity(temp:__----- ’C) 7BOO(5day)BH; Carbonaceous BOQ (5 day) 2L Soluble K)D^W) ^/Chtoridp _Cyanld0 Fluoride „ Hardness, Total as CaCOs ^B^um '■iJ'Borw:^ .7 __ Cadmium _::GaJ&tfn,a8CaCO3 < __ Chemlcal Oxygen Demand __ Nitrogen. Mimonia as N _CaIcIum,Ca«

I L- Dissolved Oxygen ’ TRErtal Oi^ante Cat»n _ PWrogen. Nitrate as N _ Nitrogen, Nitrite as N _Chromium,Total _ Chromium. Hexavalent _Senil-viotatiles

I __ ' Total Organic Halides Solids. Percent (%) Sows. Settieable __ Solids, Suspended _ Nitrogen. Tq^ Kjeldahl as N _Cobalt _ Oil and Grease —^Plfenoi . __ Phosphorus Total as P —Copper —T»on _Lead ^Pesticldes/PCB’s

_TCLP-M8fels _ Solids, Total Phosphorus, Ortho as P _ Magnesium _TCLP-Pestlcides Solids. Total Dissolved __ Sulfetes __ Manganese _TCLP-Herblcld8s _ Solids, Total Volatile __ Siirfectante __ Mercury _TCLPVoIatiies _ Other. ________ _ UV254 _ Molybdenum _TClP-BNAs _Nickel

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