NYC-WTC_000199565

NYC 9/11 Public Portal Document NEW YORK CITY DEPARTMENT OF HEALTH - BUREAU OF PUBLIC HEALS ENGINEERING 2 LAFAYETTE STREET, (1TH FL, NEW YORK, N.Y. 10007 TEL: (212) 676-1520 Fax: (212) 676-1517 REQUEST FOR BACTERIOLOGICAL ANALYSIS SAMPLING FOR J PUBLIC WATER SUPPLY 2 BOTTLED WATER | QO BEACH WATER POOL WATER WELL WATER WASTE WATER J OTHER CHAIN-OF-CUSTODY RECORD | Name of Sampling Lucatian Location Address: G Cowd “CEO Sampling Source: Date/Time Sample Taken: Sample LD. & . WROTE 4 \is\oa Vubltc Health Sanitarian I: Water Run No: tal RB SAMPLE PREPARATION: Stored @4°C: 2 Yes atu Tap: L) Ramed No! flamed NAKAO Sv@yso0 CH Comptaint (CCH): nlp FIELD TESTING: Chlorine Residual (ppm) —— pH: —— — Sample Temp (*C/°F): — Field Comments;Remarks: &2 | Received by Bureau of Labs [455 First Avenue, NY, NY 10016 Tel: (212) 447-681} . Nate: ; Time: Sample Temp (°C): Name: Sgnature. 3\ loa \ «(Sr NO TEM? Conrfa, 2 Keon SAMPLING ANALYSES LAB NOO3 (A MULTIPLE TUBE DILUTIONS (MPA) MEMBRANE FILTER COUNT (MF) IML 0.1 ML 0.01 ML 0.001 ML LT 8G “EC LT BG EC tT BG EC LT BG EC QUANTITY TOTAL FECAL : FILTERED COLIFORM COUFORM OTHER 24 | 48 | 24 | 48 | 24 j 24] 48 | 24} 48] 24 | 24 | 48 | 24 :«| 48 «| 24:44 24 | 48 | 24 | 48] 24 MIO COLO OO OO 2}QlO OM Ol1o O19 » 3,OQ}0 G1 ©O}O Old 41 O]O DIO Od ©) 0 Q s|O};O Oro QO; oO OS i No Coliform Coun ((MPI} or MF/100mi) Fecal Collform Count@MPN or MF/100ml) Standard Plate Count ( /mi) © o Date/Thne Analyzed: Date/Thoe Reported: Bactertologtst(s): Lab Comme ots/Remarkes. oO So es PHE 102 (209) ; NYC-WTC_000199565 295 IDL! 7A 77 Pree 7T PN? 4 TAN’ AKI