Ventilation System Evaluation Form, WTC Site, Feb 2003

NYC 9/11 Public Portal Document

VENTILATION SYSTEM EVALUATION FORM accompanying guidance document Please complete this form in accordance with instructions in the "art 1.0 GeneralInçor5natiOfl General .te of evaluation: S o3 Building contact name and phone: Evaluation team (list name and affiliation): vironmental professional 1AC professional) b tC.T Dusk Building address: e of Facility (check all that __ C~ 6+✓w►«I esidential Multi-use Other (describe) Date of construction: Number of floors: i Number of residential units: Prior inspection report/maintenance records available for review?:

Other comments

Ventilation system types (check all that • and indicate total no. of units) Central ventilation system I Mechanical exhaust system F.ct_ no_ of units Est. no. of units Passive shaft/duct Mechanical make-up air system Est. no. of units Est. no. of units Other (describe)

information and observations recorded on this form I certify that to the best of my knowledge, the representation of site conditions. including all attachments are a true and accurate

AC) Evaluator Date Venti t' n 's 2S/o 3 Pa .0 Vi ual Inspection Forms inspections. Complete the forms in accordance with Use the attached forms to document visual instructions in the accompanying guidance document.

NYC-WTC 000133682