Bacteriological analysis request form, NYC public water supply, Oct 2001

NYC 9/11 Public Portal Document NEW YORK CITY DEPARTMENT OF HEALTH — BUREAU OF PUBLIC HEALTH ENGINEERING 2 LAFAYETTE STREET, 11TH FL, NEW YORK, N.Y. 10007 TEL: (212) 676-1520 Fax: (212) 676-1517 REQUEST FOR BACTERIOLOGICAL ANALYSIS SAMPLING FOR JA PUBLIC WATER SUPPLY ‘3 BOTTLED WATER ' BEACH WATER ‘2 POOL WATER ‘2 WELL WATER QO WASTE WATER ( OTHER CHAIN-OF-CUSTODY RECORD Name of Sampling Location: Location Address: Warreurc a Ajeg?- ST. Sampling Source: Date/Time Sample Taken: Sample LD. 4: _S. Borough, Zip Ki FAA ~ 54 £3 89 A. LY, SAK Tley/ol- "x12 fa. MW - 4~-CR, wn Public Health Sanitarian: ID: Water Run No: yw /A SAMPLE PREPARATION: Stored @ 4'c: A Yes QNo Tap: ZA Flained © Not Flamed a — td Complaint (CC#): FIELD TESTING: Chlorine Residual (ppm): © - pH: - Oo Sample Temp (°CA Q Field Comments/Remarks: - H o Received by Bureau of Labs [455 First Avenue, NY, NY 10016 Tel: (212) 447-6811} hy Date: Time: Sample Temp (°C): Name: Signature: . —_—_—" _— g ?- 24-0) 3:30pm Ibe? Co ws) - JAYLOR SY d = 7 : g SAMPLING ANALYSES LABNO: ¢, 76 Ly. s 4 MULTIPLE TUBE DILUTIONS (MPN) MEMBRANE FILTER COUNT (MF) o 1 ML 0.1 ML 0.01 ML 0.001 ML Ba 2 a r oH LT Bc [ec] LT BG |ec!] uf BG f{ec| Lr BG | eC | QUANTITY TOTAL FECAL & coli Be) - FILTERED COLIFORM COLIFORM ERE z o£ 241 48 | 24} 48 | 24} 24} 48 | 24 | 48 } 24 | 24 | 48 |] 24 | 48 | 24 | 24 | 48] 24 | 48 | 24 ; ’ v_| wv |W , 1 S ,OoO va] ! 2 n ry 4 3 NO 4 Oo la) lee) O 5 Hi H (s N Coliform Count (MPN or(MF/100ml) Fecal Coliform Count (MPN or MF/100inI) Standard Plate Count ( /ml) 5 8 f : bok 3 Bbsent i. bsent 7 | Ss Date/Time Analyzed: Date/Time Reported: Lab Comments/Remarks: | L - oe TESTED fy : 9-24-01 SED 96 oy TE eae ex 3 | crn n° 200i POE NTA ES oy a 3:30 pm ——— = “FIRST AVE, WW NY Irae. Ww = fee) PHE 102 (2/99) ~ Oo iS NYC-WTC_000176040