NYC-WTC_000208655

NYC 9/11 Public Portal Document ALIO OO TONTZ T9OTOTZLOO NEW YORK CITY DEPARTMENT OF HEALTH ~ BUREAU OF PUBLIC LIEAL TH ENGINEERING 2 LAFAYETTE STREET, 11TH FL., NEW YORK, N.Y. 10007 TEL: (212) 676-1520 Fax: (212) 676-1517 REQUEST FOR BACTERIOLOGICAL ANALYSIS SAMPLING FOR [2 PUBLIC WATER SUPPLY ‘BOTTLED WATER Q BEACH WATER \ POOL WATER O WELL WATER 3d WASTE WATER © OTHER CHAIN-OF-CUSTODY RECORD MUARADES SinTy &£&i Complaint (CCH): ,) Jn Name of Sampling Location: Location Address: CROUp) Oo ZELO Sampling Source: abel Sample Taken: Sample LD. #: i WASTE 7/62. We ShOUND ZEeo brs? Mani Hat AN WATER / 3:30 THSS Public Health Sanitarian: ID: Water Run No: v/a SAMPLE PREPARATION: Stored @ 4°C: UG Yes No Tap: OQ Flamed DkNot Flamed FIELD) TESTING: — Chlorine Residual (ppm): 0 @ pH: »¢7 Sample Temp (°C/ - S Field Comments/Remarks: SAR PLE TALEN FROM NORTH CNS: OF LAKE Received by Bureau of Labs (455 First Avenue, NY, NY 10016 Tel: (212) 447-6811} Date: Time: Sample Temp (°C): Name: _—— _—— Signature: 7 7 SAMPLING ANALYSES LAB NO: / b 3 MULTIPLE TUBE DILUTIONS (MPN) MEMBRANE FILTER COUNT (MF) 1ML 0.1 ML 0.01 ML 0.001 MIL LT BG EC LT BG EC UP 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 213010 O10 Olo O}lo 51D |o © | 0 © 10 C10 OL© O1LO QLe Coliform Coun{(MPN or MF/100m1) Fecal Coliform Coun( (MPNor MF/100m)) Standard Plate Count ( /ml) <= 20 wp =< £0 we Date/Time Analyzed: Date/Time Reported: Bactepidlogist(s): Lab Comments/Remarks: . TESTED WY NYE DEPT. Cr} Q2-9- OL L BUREAU OF LABCRATS PHE 102 (2/99) / NYC-WTC_000208655