Part•I.0 General hnfgrmation
Date, or-Evaluation: j 11 Building contact name and phone: ..
Evaluation Team (list name and affiliation):.
flo . r1 -- ulG ~ r, (Environmental Professional)
- ac -1. (HVAC/Electrical Professional)
(Sheet Metal Professional)
Building Address: Type of Facility (check all that apply):
— q1 - i E Residential
tj kk N 0 Multi-use
Other (describe)
Number of residential units: Number of floors:
BVAC System Types (check all that apply) -
fl U- it verrtilator (cLnele residence unit) I \\ •all/window AC unit (single, residence unit)
Fan coil uait (single re idence unit) Central ventilation system
Heat pump unit (single residence unit) Passive shaft duct
fl Ober (describe)
Location of outside air intake:
Outside air intake accessible for inspection Y N (explain)
Part 2.0 Checklists
2.1 Ventilators, all air conditioning units and window air conditionint :nits in common spaces
Ventilation System Identification: Pr. A
n r1 .~ .Xis Si —Sr
Location:
I wO r_
Access adequate for inspection of components: S
Dust'Dirt / Debris Suspect \1'TC-Re; ted Dust
System Component
Substrate Material
(sheet
( s',ra PP ed) Lirht Heavy
System Components (sheet metal lined) No (<i/l6 inch (> 1/16 inch Present % Estimate °'of rota.t .d
m_t_ .c
(fiberglass) depth) depth (~ ^) loading
(flexible connector)
(double walled)
Outsde air ir.tat.e louvers, grates
and'or screens
Ou:stde air duct I I I I I
Outside a:r damper(s) I I I I I
Return air grille I I
Return air plena r. I . I I
Filter rack
Filter media
Coils (evapora:or)
Blower assembly
Condensate drain, pan I I I I
In-line electrical resistance strip
hearers (in supply ducts I I I
connected to unit venrllators)
Fire dampers
P I I I I
Tumins vanes I I
I
Supply air plenum or supply duct
Supply air plenum or supply duct
liner
Supplyair diffuser
2.1 Ventilators, wall air conditioning units and window air conditioning units in common
spaces (coat.)
NYC-WTC 000099515
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000099515Source: NYC Law Department, mirrored locally