NYC-WTC_000199549

NYC 9/11 Public Portal Document

NEW YORK cm' DEPARTMENT OF HEALTH - BUREAU OF PUBLIC UEAI/n I ENGINEFXING 2 LAFAYETTE STREET, 1ITH FL., NEW YORK, N.Y. 10007 TEE (212) 676-1520 Fax:(212) 676-1517

REQUEST FOR BACTERIOLOGICAL ANALYSIS SAMPUNGFOR <-3 PUBUC WATER SUPPLY 'J BOTTLED WATER '3 BEACH WATER POOL WATER ^WELLWATER Lj WASTE WATER MOTHER CHAIN-OF-CUSTODY RECORD Name ol Samplinj; Location: Location Address: C. iTT Samplinj; Source: Date/Time Sample Taken: Sample I D. #: Borough, Zip P'A'J M ( oGb")

I'ubllc Health Sanitarian: ID: Water Run No: SAMPLE PREPARATION: Stored t® 4°C: O No Tap: JJ Flaincil Fldiiietl Complaint (CC#): HELD TESTING: Chlorine Residual (ppm): pH: Sample Temp ("C/'D:

Field Comment.s/Remarks:

Received by Bureau ol Lab.s [45.5 First Avenue, NY. NY 10016 Tel: (212) 447-6811 ] Date: Time: Sample Temp (°C): Namt>,, Signature

SAMPLING ANALYSES LAB NO: MULTIPLE TUBE DlLUnONS (MPN) MEMBRANE II LIT R COUNT (MF) 1 ML 0.1 ML 0.01 ML 0.001 ML LT BG EC LT BG EC LT BG EC LT BG EC (QUANTITY TOTAL FECAL fcV. FILTERED COLIFORM COLIFORM 0144 F« 24 48 24 48 24 24 48 24 48 24 24 48 24 48 24 24 48 24 48 24

1 N 2

3

4 o H 5 K I

I R o o o o co Coliform Count (MPN o^^Vl^(IOmI) i

Date/Tlme Analyzed: Date/Tliiie Reiwrted: Fecal Coliform Count (MPN or\JMF/100inh {\V)scc)-4- Lab Comments/Reinarks: .0FMrj.ni .!o;;trs SUuidard Plate Count ( /ml)

I o 11 20®' pp:'; ■■ f'i ttt’C'i.Mt'o.r JJ.yDfiSr AVt, ii7 lOOlb to co 7t7 77

NYC-WTC_000199549