NYC-WTC_000196015

NYC 9/11 Public Portal Document

NEW YORK CITY DEPARTMENT OF HEALTH - UURFjYU OF PUBUC HEALTH E.NGINEERINO 2 LAFAYETTE STREET, 1ITH FL, NEW YORK, N.Y. 10007 TEL (212) 676-1520 Fax:(212) 676-1517

REQUEST FOR BACTERIOLOGICAL ANALYSIS SAMPLING FOR □ PUBUC WATER SUPPLY □ BOTTLED WATER □ BEACH WATER □ P(X)L WATER □ WEU WATER X WASTE WATER □ OTHER

CHAIN-OF-CUSTODY RECORD Name of Sampling Loealion: Location Addres.s: Sampling Source: Date/Time Sample Taken; Sample I D. K;

Ia)T. C , Borough, Zip rcfsiJ 1^'30 TF litis Public Health Sanitarian: ID: Water Run No: SAMPLE PREPARATION: Stored 0 4’C: O Yes ^ILiNo Tap: unbilled Not Flamed

U/ Complaint (CC#); FIELD TESTING: Chlorine Re.sidual (ppm):---- pH; Sample Temp ("C/'D: ___

Field Comments/RemarLs:

zw; pc^ Received by Bureau of Labs [455 First Avenue, NY, NY 10016 Tel: (212) 447-6811 ] Date: Time: Sample Temp (°C): . Name: Signature:

LAB NO: / SAMPLING ANALYSES

MULTIPLE TUBE DlLUllONS (MPN) MEMBRANE FITTER COUNT (MF)

1 ML 0.1 ML 0.01 ML ().()() 1 ML LT BG EC LT BG EC IT BG EC LT BG EC QUANTITY TOTAL FECAL FILTERED COLIFORM COLIFORM OTHER 24 48 24 48 24 24 48 24 48 24 24 48 24 48 24 24 48 24 48 24

I O OO o o o o 2 o 4- OO o O o o O 3 O o o o o 4 o o o o o o o 5 o V o C) o o Oo o o c o I Coliform Coun^(AlP^or MF/lOOml) Fecal Coliform CouuINMPWor MF/lOOmI) Standard Plate Count ( /ml)

Date/Tlme Analyzed: Dalc/Tlinc Rejxjrted: BaclerlologijitU): Lah CoiniuciiLs/Kcniarks: I I FEB 1 9 2002 ■ PH E 102 (2/99)

NYC-WTC_000196015