Part 1.0 General Xnfprmation
Date of Evaluation: / ijo I Building contact name and phone:
r2-- 2.t ..- 2„oD
Evaluation Team (list name and affiliation):.
oh S S 1 14. £ (JJ (Environmental Professional)
0
(HVAC/Electrical Professional)
rt I — (Sheet Metal Professional)
Building Address: Type of Facility (check all that apply):
K ►4' JbAJE , Residential .
NFw 0 Multi-use
•
Other (describe)
Number of residential units: "' T. Number of floors:
HVAC System Types (check all that apply) -
Unit ventilator (single residence unit). Wall/window AC unit (single residence unit)
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)
Part 2.0 Checklists
2.1 Ventilators, wall air conditioning units and window air conditioning►:nits In common spaces
Ventilation Systemidentifcation:
Location: ,
OF ;'- QAS£M~.•rrT
Access adequate for inspection of components:
lIE S
Dust/Dirt /Debris Suspect %VTC-Related Dust
System Component
Substrate Material
(sheet metal wrapped) Light Heavy
System Components (sheet metal lined) None (<1116 inch •
(2 1/16 inch Present? Estimate °o of total dust
(fiberglass) depth) depth (YIN) loading
(flexible connector)
(double walled)
Outside air intake loners, grates
and/or screens
Outside air duct
Outside air damper(s)
Return air grille ft _, L
Return air plenum . ~ra .
Filter rack
Filter media
Coils (evaporator)
Blower assembly ,C .t e Tq
Condensate drain pan
In-line electrical resistance strip
heaters (in supply ducts
connected to unit ventilators)
Fire dampers
Turning vanes
Supply 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 000117637
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000117637Source: NYC Law Department, mirrored locally