NYC 9/11 Public Portal Document
• VENTILATION SYSTEM EVALUATION FORM
Part 1.0 General Information
Date of Evaluation: — .. o J Building contact name and phone: 01 B G
?J2 3Zt -- 000
Evaluation Team (list name and affiliation):
#Z,qgOV (Environmental Professional)
K"T Orfi 4Th44l u.0 -- vs-t` (HVAC/ElectricaI Professional)
Es'
(Sheet Metal Professional)
Building Address: Type of Facility (check all that apply):
31 t)dT4 paJ i1 Residential
Multi-use
Other (describe)
Number o residential units: 585 Number of floors: rj$
HVAC System Types (check all that apply)
Unit ventilator (single residence unit) Wall/window AC unit (single residence unit)
fl Fan coil unit (single residence unit) Central ventilation system
Heat pump unit (single residence unit) Passive shaft/duct
Other (describe)
Location of outside air intake:
Outside air intake accessible for inspection Y N (explain)
rant 2.1) Checklists
2.1 Ventilators, wall air conditioning units and window air conditioning units in common spaces
Ventilatinn fivctf rA
Q r ' t.p •t
Location: WE ` r
A A C. v Sant` A'Tr'Rc•H-.t~' t.* ST
Access adequate for inspection of components:
Dust/Dirt / Debris Suspect WTC-Related Dust
System Component
Substrate Material
(sheet metal wrapped) Light Heavy
System Components (sheet metal lined) None (<1/16 inch (Z 1/16 inch present? Estimate % of total dust
(fiberglass) depth) depth (''1 ) loading
(flexible connector)
(double walled)
Outside air intake louvers, grates
and/or screens
Outside air duct
Outside air damper(s) ojj wEtaJL
Return air grille w -t V'
Return air plenum
Filter rack
Filter media
Coils (evaporator)
Blower assembly
Condensate d►ain pan
In-line electrical resistance strip
heaters (in supply ducts
connected to unit ventilators)
Fire dampers
Turning vanes
Supp y air plenum or supply duct
Supply air plenum or supply duct
liner
Supply air diffuser
2.1 Ventilators, wall air conditioning units and window air conditioning units in
common spaces (cont.)
NYC-WTC 000117448
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000117448Source: NYC Law Department, mirrored locally