,' Part 1.0 General I,nforimation
Date of E~raluatioa: -) t- . Building:contact name and phone: ..
Evaluation Team (list name and affiliation):. '
(Envirorunental Professional)
q S (HVAC/Electrical Professional)
(Sheet Metal Professional)
Building Address: Type of Facility (check all that apply):
R WA lResidential
Gw ; ZiL Multi-use '
•• - Other (describe)
Number.of residential units: Number of floors:
I3VAC System Types (check all that apply)
Unit ventilator (single residence unit)
I f J \ allh'rindow•AC unit (single residence unit)
Fan coil unit (single re idence unit) , • Central ventilation system
Heatpump unit (single residence unit) Passive shaft/duct
fl Otber'(descn'bt)
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 System identification: -
Location: 0g •
.
Access adequate for inspection of components: o s_.
Dust/Dirt/Debris Suspect WTC-Related Dust
System Component
Substrate Material
(sheet metal wrapped) Light Heavy
System Components (sheet metal lined) None (<1/16 inch (a 1/16 inch present? Estimate % of total dust
(fiberglass) depth) depth ( loading
(flexible connector)
(double walled)
Outside air intake louvers, grates I ,
and,'or screens
Outside air duct i
Outside air damper(s)
Return air grille • -
Return air plenum -
Filter rack
Filter media
Coils (evaporator) -
Blower assembly
Condensate drain pan
In-line electrical resistance strip
hea:ers (in supply ducts
connected to unit ventilators)
Fire dampers .
0
Turning vanes •I
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 000132703
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000132703Source: NYC Law Department, mirrored locally