NYC-WTC_000196016

NYC 9/11 Public Portal Document

NEW YORK CIT Y UEi»ARTMENT OF I H ALT! I - BURIAU OF PUUiJC HEALTH ENGINEFXING 2 LAFAYETTE STREET, 1ITH FL., NEW YORK, N.Y. 10007 TEL (212) 676-1520 Fax: (212) 676-1517

REQUEST FOR BACTERIOLOGICAL ANALYSIS SAMPLING FOR □ PUBLIC WATER SUPPLY □ BOETLED WATER □ BEACH WATER □ Pa)L WATER □ WELL WATER WATER □ OTHER

CHAIN-OF-CUSTODY RECORD Name of Sampliny Localion: Location Address: lO O SanipliniJ Source: Date/Time Sample Taken: Sample 1.0. #: iaIa^t-c ^(1/6:3. Borougii, Zip Mpf^nfi^rr PtJ f3:3 0 THSS. Public Health Sanitarian; II): Water Run No: fj/A SAMPLE. PREPARATION: Stored 0 4’C: LI Yes Tap: O Flamed Flamed

Complanit (CCD). j FIELD TESTING: Chlorine Residual (ppm): 0 '<? 4 'S^ Sample Temp (^/(^ 5'3” -6^/ Field Comments/Remark.s:

Received by Bureau of Labs [45.5 First Avenue, NY, NY 10016 Tel: (212) 447-6811] Date: Time: Sample Temp ("C): Name: ' Si.i; nature:

2- J. LAB NO: / / g SAMPLING ANALYSES

MULTIPLE niBE DILUTIONS (MPN) MEMBRANE IT I.TER COUNT (MF)

1 Mt, (1.1 ML 0.01 ML 0.001 ML LT BG EC LT BG EC l.T 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

1 0 o (9 o o 0 2 o 0 o 0 0 o o o 3 o 0 o o o 9 o 0 4 o 0 o 0 9 o 0 5 0 o 0 o 0 o 0 H K Q Q o <9 (O I Coliform CoimY(MPNlor MF/1 OOinl) „ Fecal Coliform CouiiUM^or MF/lOOinl) Standard Plate Count ( /ml)

I Dale/Tlme Analyzed; Date/Tline Reported: Lab Commeuls/Remarks:

T~ o o I o 7- o Z: pre FEB 1 1. 2002 i i PH E 102 (2«9) CO I ON '

NYC-WTC_000196016