NYC 9/11 Public Portal Document
• _ ' ` '4'ENS' 1FA
Trli~tittn~rtROM
Part 10 General for 9 1ation `
•~ Date of Evaluation: ii/s./oz'' Building contact naive and phone:
Evaluation Team (list name and affiliation)
(Environ 1i ntalProfessional)
—or+ G cj t
(HVAC/Electrical Professional)
•`
Building (Sheet Metal Professional)
Address: Type of Facility (check all that apply):
-Residential
,jr_~,+ 2lL' Multi-use
•
Other (describe)
Number of resideritiaj units: Number of floors:
HVAC System T)pes (check all that apply)
Unit entilator`(single residence unit).
Vall/window AC unit (single residence u it)
Fan coil unit (single re idence unfit)
Central ventilation system
Heat:pump unit (single residence unit) •
Passive shaftlduct.
Other(describe}
Location of outside air intake•:
Outside.air intake accessible for•irispection • . Y N (explain)
Part 2.0 I Checklists
2.1 Ventilators, wall air conditioning units and window air
conditionine :nits in common cnarac
2.1 Ventiiatoi•s, wall air conditioning units and window air
conditioning units in common spaces (coat.) .•
NYC-WTC 000132698
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000132698Source: NYC Law Department, mirrored locally