Chain of custody record, Westchester County Department of Labs &

NYC 9/11 Public Portal Document

ENViRONMENTAL SERVICES SAMPLE SUBMISSION FORM XT II .com; WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla, New York 10595 (914)231-1620 Fax (PM) 231-1772.y / ff

Oliisrt/ ■»< NYS-ELAP No. 10108 Time/Date Set: ■•■i Form A-70 (rev. 10/01) ---------------------------------------------------------------------------------------------------------------------------------------------------------- 1

Samgle Type (circle one): p P E Q' Potaty 3. Non Potable Treated B„,„e#s:'2Yx2A.U. 2. NonPotnhIe 1. Other .(....................... ...................... Chain of Ciit tody?; Yes No I Time/Date Collected: Comments:____ i I t Collected By: M

Cofiectod From; Agency Code:PWS #: ;

Bitt to; . . Source ID:Type Descriptor:; 4 3 I ill Location’s/lndividual's Name Name/Company _ street----------------------- Street; 4 HE City/St/Zip____________i CityZSt'Zip Identification of Source Phone#:: __ Fax#:. M Collection Point CA.CH, Bl?Check#:Amounts ; i SACTERiOLOGiCAL. ANALYSIS Lab#:___ i ■ ■N « Lab#:_____________________ _ ORGANIC POTABLE ANALYSIS ORGANIC NON POTABLE/SOLID ANALYSIS ' ieterotrophic Plate Count imodialysis & ail others) diform P/A (Pubiic supplies) __ Trihalomethanes (524) __ Volatile Halocarbons (524) __ Volatile Aromatics (524) _ Purgeable Halocarbons (624/8260) __ Purgeable Aromatics (624/8260) ALHOktin K Acrvioiiilriie i8260) s __ Coliform MPN (priv well, raw, stp) __ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/80811 ■lit

I■1 __ Microscopic __ Microextractables (504) PCOY/Aroohlms) (B0H/H081) __ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630.8151) _ API _ PCB as Decachlorobiphenyl (508A) Other Pesticides (SM18/6630) __ Other:; __ Herbicides (515) ... I’otroi.ium Hviiro.;mhoii Scan (.110-13) __ Pesticides (525) ___ Glycols in Water lO j Refrigerated? Chlorinated:? yes no yes - no __ Carbamate Pesticides (531) __ Glyphosate (547) . A- :d r x!m;J3liles (025/8270; Sase Neutral Extractables (625/8270) ■ __ ,Diquat .(549), Free Chlorine Res: Total Chlorine Res:___ ; - mg/L mg/L __ Chlorination Disinfection Byproducts (551) __ Haloacetic Acids (552) __ GC/MS Unknown Scan __ Phthalates (606iViS) __ Other: ■ I pH ____________ ___ other Pesticides (SM18/6630) ■■ s UCMR List 1 "RAOioCHETvilCAlAN ___ MtBE Only (524) __ Radon __ Other________________ Ia iNORGANiC ANALYSIS REQUESTED - i -ih#: _ Color _ Acidity Aluminum ___ Potassium 8® __ Turbidity „ Alkalinity y Antimony jZ. Selenium lillBI pH _ Bromide y Arsenic iZ. Silver Conductivity __ Bromate/Chlorate/Chlorite jZ Barium _ _ Sodium 111 Corrosivity (temp:; °C) im __ Chloride ./ Bmvilium Z. Thallium _ BOD (5 day) __ Cyanide Boron Vanadium 0 .. . Ciirbonaceous BDD (5 dnv) liuohUe Cndmuin; 2 Zinc __ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Calcium, as CaC'O ; __ Chemical Oxygen Demand __ Nitrogen, Ammonia as N Calcium, Ca-"2 _ Metals/CN __ Dissolved Oxygen __ Nitrogen, Nitrate as N Zchromium, Total',. __ Volatiles ■I __ Total Organic Carbon __ Nitrogen, Nitrite as N Chromium, hexavalent __ Total Organic Halides ,/ Cobnii __ Semi-vioiatiles __ Nitrogen, Total Kjeldahl as N __ Solids, Percent (%) __ Oil and Grease ZCopper ; _ __ Pesticides/PCB’s ■ M __ Solids, Settleable __ Phenol Y'-'-' "• ' " TCL.P __ Solids, Suspended __ Solids, Total __ Phosphorus Total as P __ Phosphorus, Ortho ..as P 4 Lead Magnesium , . ' P. ... 1CLP-Mek!ls B ■“ZYSoTasTTotaTDi'sgTrvsd' , _yrCU2-Pe68ei<te8-- Miingmicse Solids, Total Volatile __ TCLP-Herbicides ;; __ Surfactants srcury Other: *:»y\_______ ; _ TCLP-Volatiles UV254 Molybdenum _ TCLP-BNAs Nickel ______ laioiiiiiilio NYC-WTC_000075114