PHOTOS TAKEN YTS I NO
BASIS OF INSPECT.' i h u or
BLDG TYPE
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^ TORS NAME
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CITY SAMPLE NQ
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PHON SAMPLE NQ
STATE ■{ ZIP j\[ 3
Iv OW ERS NAME
LABO A RYNAME P
W ADDRESS - CITY
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ADORES CITY N
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TIME OF INSPECTION FROM: TO:
CONTACT PERSON: tQ
INSPECTION DISCLOSED:
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RESULT CODE
Nov I IFRACTIONS
SUPERVISORS INITIALS I
NOV I
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3 • BROOKLYN 4 - OUEENS 5 .RICHMOND
BORO I - MANHATTAN 2 . BRONX
BLDG TYPE A > ! Stories B <5 Stories C S nple Family
0 School f Noepital P Public Owned Property
RESULT CODES 7 . Violation Issued 2 . No Violations Issued 3 - Wo ACCTS$
A - Protect not Started (No NOV) S - Prolecl Comp4rled (No NOV)
FILE
NYC-WTC 000118800
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000118800Source: NYC Law Department, mirrored locally
Blank or template asbestos inspection report form with fields for building premises, contractor information, sample collection, and laboratory analysis.