COC#.72633 i Cust. ID: 1085 eceived: 09/18/2025 3;11 PM 3;11 PM PM ‘|| | | i| ,| : Ices | VOSS VOSS :
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2 me es COC#.72633 By J 1a, Cust. ID: 1085 bivw EB | £ RSC, LLC, eceived: 09/18/2025 3;11 PM 3;11 PM PM -— —rt=~= — ——“ — sSsinissionOO—S(a form New York State Chain-of-Custody WASTEWATER Bill-to oh een Seen Mountain Road, Ferndale, New York, 12734/ Phone: 845.704.8151 / Fax: 845.414.0051 ; Customer Information: (C51276) Well/System Location Information Name:ustome {120 Innovation' { JCO Inc. } Name or PWS:\Villagea of Red Hook Town:Address:|POUGHKEEPSIE4 Commerce StreetState: NY Zip: 12603 Town:Address:—([Red_ {VillageHook of Red HookState: NY Zip: 12571 Phone:_ (845) 486-1030 NYSPWS-ID; | ‘ : : Contact Email: |SulvantResilts@h2einnevation-com AZOUNOVEAOorichess \ Kesc\ts Les Coon Fox [| SSSA, Co @ Sion?Name: (845-540es 31S a L.0 ‘$"D Ices | VOSS VOSS 10 CRR-NY 5-1.74 of the NY State Code requires the owner of a public water system shali ensure the approved environmental laboratory performing the analyses sends faboratory results to the Dept. of Health in a manner prescribed by them. Initia! here if you want us fo forward your results to the Dept. of Health. Note: itis your responsibility to verify that they receiveIt. Customer Sample Collection Data Bottle : Date Time [Initials Who i Sample#P C/Gf SampleP Point Sampled] Sampled | Sampled Test Re q uested - ELAP/EPA! Method j|Comments/Sample! P Tem P 1] BGP ea | crliuent qig/25| 224APY LC BOD AB 2] Wes! ig Maflvent ales |; Zl oC [TSS LB Cl eMluent /Aliz/es|t ae] ic | BOD 18 4] 26855 GlER ens ( fisashert ae] bc [TSS 1% 5| AUG SB GlEMiven —_ [lisizs [p84 ae] LC Ache Amonne_(o @ uD lew el PUSS 7 [Gletewvens —_ plvles faca) pL el Sample Anivel . a . Recéived SS GLa ="Received , Relinquished d By’!By } pe\r.\y BD Cow ee Relielinquis hed To: /L—“ — Date / (/§,Taea Time cee3 Wf oo, : ar Received Received Relinquishedelinquished By:By Relinquishedq To: Date Time. Sullivan County Labs terms and conditions found oa www.SullivanCountyLabs.com. Public water systems are required to report results to the local Dept. of Heaith office. When necessary, we reserve the right to subcontract testing to accredited Jaboratories that are certified by the state from ourhichceritificatethe sampieof wasresuitstaken.with Circumstancesits approved ELAP might#. require us to send your sample to an affiliated lab, either due to instrument backtog, hold time iimitatlons, ar non-accreditation in a Particular test. You are giving us permission to da so by signing this COC, The alternate lab wil! be shown on ----- End of picture text -----