NYC 9/11 Public Portal Document
PAGE 101L
ASEES1t4t5 INSPECTION, REPORT
..
tEMISE NQ -.-
STREET
SQUAD a
T
BADGE e
'C3.L"' t'
BORO CbDE BLOCK LOT
2]P
TAKEN YES I NO
BLDG TYPE BASIS OF INSPECT ç' p
` L~tN1P
SAMPLE NO a~
vNTRACTORS NAME gar ~~ ' 2a•~
SAMPLE NQ
i► RESS CITY W w t
t7 to Q~S i aCt
PHON SAMPLE NQ
STATE ZIP
3
OWNERS NAME
1 A RY%AME ~£ A
!' DRESS OTY
E COY
•
STATE , ZIP PHONE
STATE ,j ZIP 1 bor. ° LZ — d
TIME OF INSPECTION FROM: (p TO:
CONTACT PERSON
MISPECTION DISCLOSED:
RESULT CODE
NW f INFRACTIONS
# SUPERVISORS ITIAts
Nov
A • BROI•!St $ w BROOKLYN 4 • QUEENS 6 RICHMOND
OORO I s MANHATTAN
BLDG tYPE A > 6 Sbitea . 5<8 Swiss C 1)inpk Family
D School f Mospitll _ F Itiodc Owned Plol*ty
RESULT CODES I • violation Issued 2 - Ne Violations Issued 3 - No Access
Ate 30A
a a Project not Startcd (No NOV) Pi t Crfrnrl*tom! SNnt OV)
F11 F
NYC-WTC_000099616
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000099616Source: NYC Law Department, mirrored locally
Blank or template asbestos inspection report form with fields for building premises, contractor information, sample collection, and laboratory analysis.