NYC 9/11 Public Portal Document
ASBESTOS INSPECTION REPORT PAGE 1 OF
PREMISE NO STAFET tNSPECnON DATE
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ZIP
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PHOTOS TAKEN YES I NO
CONTRACTORS NAME `& , /) -L SAMPLE NQ
A ORESS n e1g A CITY SAMPLE NQ
STATE ZIP • ' PHON - D SAMPLE NO.
LABORATORY NAME OWNERS NAME
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AS! i s S CITY N ADDRESS CRY
STATE t ZIP y~o Hp 7 STATE ZIP
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CONTACT PERSON: TIME OF INSPECTION FROM: _/ aml TO:
INSPECTION DISCLOSED:
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Nov. INFRACTIONS RESULT CODE
NOV
♦ SUPERV.SORS INITIALS
BORO I - MANHATTAN 2 - BRONX 3 - BROOKLYN 4 - QUEENS 5 .RICHMOND
BLDG TYPE A > 6 Storks B <6 Stories C Single Family
D School E Hospital F Pudic Owned Property
RESULT CODES I - Violation Issued 2 - No Violations Issued • 3 . No Access
4 - Project not Started (No NOV) 5 - Project Completed (No NOV) ACP 3X3
NYC-WTC 000127283
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