Chain of custody record, Westchester County Department of Labs &

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH

(914) 231-1620 Fax (914) 231-1772 .... . .... . Nys-ELAP No: .10108- : FdrmA^oWlO/oW (drctecme):

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• Collected By: KjMvxyqV 3. Non Potable Treated 4. Other

Agency Code: . Bottle #’s; c|a^^Cu8^)^|S

PWS #; Type Descriptor ^4

'" <■'/ Lp«atl<M)'8rindlvidual’8 Name;/Waw/<>win{^^j^ Y'-l " JlMS/',/' .. c t. I ~a^D. ' : - / ' aa^- yY, H^2*s-a Z-SSSSSS: ------- —— — |;OA.CH,BITiLi£. Check#; Is 11 BACTERlCiLOGlCAL analysis W——— ORGANIC POTABLE ANALySiS ' otnera) ■L»Trihal«iBii^ • ■• (ig^CpIiform/FyAXPublic supplies) si^ COliforpiMPI^ (prtvWl. raw; dp) _ Volatile Halocarbons (524) ^j.\WliAA»w^ , . - Acfolih,&Acrylonitrfl8.(8260):.>:^^3.,S; I ;^|<^^bl^‘{aIl.<^pl88T;:“ O-TWTrihaiomethanePotential (510) , Mlcroextractables (504) ' ' /' - -PCgWWSag^ _PesticW8s/PCBscreen(508) <5 ^ FCSas Deca^ldrobiphenyl (508A) _ OtheriFasticldes (SM18/Se30) ' . - WAPI <W J _ Pesticides (525) —Glycpis in Water J^Werated? yes___ no^ . __ Carbamate Pesticides (531) __ Acid Extractables (626/8270) g^^:^fc;y00_no;. ^Glyphbsatey (547) _Diquat <549) _ Chlorination Disinfection Byproducts (551) jiZGC/MS Unknown Scan' __ Phthalates (606MS) : V I , Total Chicane Res:mg/L _Haioac8tlcAcids (552) ' ' _Otb«' Pesticides (SMI8/6630) __UCMRList1 Y-’> "■ 1 _MtBE Only (524) r*? ■'•

„Radon 1 / IN^RGANIC ANALYSIS REQUESTED - Lab#: - ' 'h Y ' \ ■‘S -_ 'Aridity V ' ■^js^^ui^inum ^PpteiMiur|/, “ — pH ■■ ' __ ^^jNkalinlty :__BfBrrilde , . ^ZAntlmony \>Arsenlc 3 1 _ Bromate/Chlorate/Chiorite ^Barium \ .l,,^alllurri|:Y£y I i L£,BCfe;j^day),.. Csitbbriaceous BOD (5 day) l^ubleBOD (5day); _ Chloride _ Cyanide __ Fluoride _ Hardness. Total 08 CaCOa ju/Berylllum „ Boron , _ Cadmium _Caldum.asCaCO3 _\tenadiurrt -hZZInc. CLE^ Chemical Oxygen Demand CS^|y^O>^en __ Nitrogen, Ammonia as N __ Nitrogen, Nitrate as N _^lclum,Ca*? jkXEnromlum, Total „Metais/CN a ii’’ __ Total Organic Carbon „TotaiOrganic Halides __ Sollds, Percent j%) _ Nitrogen, Nitrite as N _ Nitrogen. Total Kjeldahl as N _ Oil and Grease __ Chromium, Hexavalent

.izGopper __Volatiies u^SemirviolatllesY.. __Pestlcide8/PCB’s *;?. I;4 __Sollds,Settleable __ Phenol k Solids. Suspended „ Phosphorus Total as P jnron tcLp ^TCLP-Metals . ( _ Solids. ,Total . __ Phosphorus. Ortho as P __ ^gneslum _TCLP-Pestlcides Solids, Total Dissolved _ Sulfates ^s^^nganese „TCLP-He±lcides Volatile _ Surfactants ju^eroury _TCLP-Volatiles \Y- _ UV254 vfMoMxteuffn; I C. ;,■ - j^^^lctel .

NYC-WTC_000075124