AEaA13E NQ STREET
o A-D tJ fr/ y a2--
i ; — . ''[ 2
v W€s(
BADGE
SOCK LC7R $OD I
21P BORO CODE
TAKEN YES I NO
$P
P G.urzP ~ BLDG TYPE BASiS OF IM
MPLE NO.
!5 ? NM.L~P1..
'.ONTRACTORS NAME gfQ. Ce~1r 2a~..,.
EAMPLE NO
RE$S p..t.1S ,Ate
CITY
Its a.nSi A-Ci
r5 a MPLE NO
STATE ZIP t PHO
A
'1
RY NAME
WNERSNAME
W E
-
l
€-L
CITY ODRESS CITY
A S
~
QQR O ATE +4 21P PHONE
STATE a ZIPSP! bO Z •~ b
IME OF INSPECTION FROM: +çwJ t0
CONTACT PERSON
INSPECTION DISCLOSED:
RESULT CODE
NOV 0
NOJ s
4NFRACTIONS
SUPER
s
SORO I - MANHATTAN 2 • BRONX 3 • BROOKLYN 4 • QUEENS 5 -RICHMOND
BLDG TYPE A > B Stoehr S <S SIOriss C *ingle Family
0 School £ Hospital ,K Is Public Owned P10PMtY
wESUt.T C00ES t - Violation Issustk 2 - No Vichtions Issued 3 • No Ateaas
4 _ Project not Started (No_ NOV) \ - •- $ e Prolact F,ompisIed (No NOV)
FILE
NYC-WTC 000099619
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000099619Source: NYC Law Department, mirrored locally
Blank or template asbestos inspection report form with fields for building premises, contractor information, sample collection, and laboratory analysis.