NYC-WTC_000196018

NYC 9/11 Public Portal Document

8^. NEW YORK CITY DEPARTMENT OF HEALTH - BUREAU OF PUBUC I lEALQI ENGINEERING 2 LAFAYETTE STREET, 11 TH FL., NEW YORK, N.Y. 10007 TEL: (212) 676-1520 Fax: (212) 676-I5I7

REQUEST FOR BACTERIOLOGICAL ANALYSIS SAMPLING FOR U PUOUC WATER SUPPLY □ BOTTLED WATER □ BEACH WATER □ PYX)L WATER □ WELL WATER Xl H'ASTE WATT/? □ OTflER CHAIN-OF-CUSTODY RECORD Name ol Sampling Location: Location Addre.ss: (2.OU f\} D Sampling Source: Date/Timc Sample Taken: Sample I D. II: i/JASrc ' LO. T, C Borough, Zip PIAaJH^'FT/I A) I y: 30 T GS Public Health Sanitarian. ID: Water Run No: SAMI’LE I’REI’ARATION: Stored © 4’C; □ Yes St/Vo Tap; £J Flamed Flamed

had s //ecTL'i (>2/ Complaint (CCd); /\j FIELD TESTING; Chlorine Residual (ppm): pH: Sample Temp ("C/’F)'

Field Commenls/RemarLs: F/2.orv. •S o LATt) G fOO 'BeW IfJO S’Cl4/2/2 7 P iT , Received by Bureau ol tabs [45.5 First Avenue, NY, NY 10016 Tel: (212) 447-681 1] Date; Time: Sample Temp ('C): Name;n Signature: CO6^,

LAB NO: O% SAMPLING ANALYSES MULTIPLE TUBE DILUTIONS (MPN) MEMBRANE RLTER COUNT (MF) 1 ML 0.1 ML 0.01 ML ().()() 1 ML LT EC LT EC LT EC LT 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 o o C?o o o o 2 O o o n O Q o 3 o o O o aD o o 4 o o o o o (1 D Q H 5 D O o Z2 O o o a c I K ! G O G Ol I I I O Coliform Coun^^PN^ MF/lOOnil) Fecal Coliform Count .IF/lOOinl) Standard Plate Count (/ml) £

I o o o o Dale/Rme Analyzed: Dale/Tliiie Rc|>orted; Bacterlologlst(^: I ft Lab Comineuts/Rcniarks: ■ :■ o 4 ,. -h

CT ; 21 2QQ2 o.tj

L7 O PH E 102 (2/99) 7 NYC-WTC_000196018