VENTILATION SYSTEM EVALUATION FORM
Please complete this form in accordance with
instructions in the accompanying guidance
document
Paa-t 1.0 General It for ation
• Date of evaluation:
02/i2/o3 I Building, contact name and hone:
• Eya?station team (list name and affiliation):
Tom, GRI- LO (Environmental professional
Dvc~ . ! 2 S
Bui!iing address: (HVACprofessional)
"re of Facility (check all that ppIL:
Residential
New ~-
__ Multi-use
Other (describe)
Date of construction: -- --
Number of residential units:
Number Of floor;-
Prior inspection repa'rt'maintenance records available
for review?:
Other comments
Ventilation system types (check all that a > ply and
indicate total no. of units)
Central ventilation system
Mechanical exhaust sVstenl
Est. no. of units
__— Est. no. of units
i\iechanical make-up air system
Passive sh. i'duct
FSt. no of units
lat no. of units f
Other (describe)
1 certify that to the best of my
knowledge, the information and observations recorded
including all attachments are a true and accurate on this form
representation of site conditions.
Ventilation System (1IVAC) Evaluator
])at c j
~3
Part 2.0 Visual Inspection Forms
Use the attached forms to document visual
inspections. Complete the forms in accordance
instructions in the accompanying guidance document. witil
•
NYC-WTC 000130429
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000130429Source: NYC Law Department, mirrored locally
An HVAC inspection report from Cole Consulting Corporation dated February 13, 2003, recommending cleaning of units at 275 Greenwich Street due to WTC dust.