HVAC component inventory, 300 Albany St

NYC 9/11 Public Portal Document LATION SYSTEM EVALUATION 'RR.M Please complete this form in accordance with instructions in the accompanying guidance document Part 1.0 General Infarmatinn Date of evaluation: / ! 5/03 Evaluation team (list name and affiliation): I Building contact name and phone:

T~=.►i (Environmental professional) (HVAC professional) Building address: Type of Facility (check all that apply): 30v ArJ Residential o ve— Multi-use Other (describe) Date of construction: Number of residents units: Number of floors: Prior inspection report/maintenance records available for review?:

Other comments

Ventilation system types (check all that apply and indicate total no. of units) Central ventilation system Mechanical exhaust system

Est. no. of units Est. no. of units / c/ Mechanical make-up air system Passive shaft/duct

Est. no. of units Est. no. of units Other (describe)

I certify that to the best of my knowledge, the information and observations recorded on this form including all attachments are a true and accurate representation of site conditions. / '

Vet}Y do /' VAC) Evaluator' ' . Date 7/ 1 2. 21 .

Visual Inspection Forms Use the attached forms to document visual inspections. Complete the forms in accordance with instructions in the accompanying guidancelditcument.

NYC-WTC 000116326