--Paif 1.0 General Information .
Date of Evaluation: j' . Z Building contact name and phone: :
•Evaluation Teain (list name•and affiliation):. '
"c:r,' -3tic 4.i. •. (Environmental.Professional)
r :s w •' •
' • (HVAC lectrical Professional)
(Sheet Metal Pro essional)
Building Address: Type of Facility (check all that apply):
FaA--wk..t 'z , Sr. Residential
U Multiuse
Other•(descnioe) • • .
Number.of residential units: 1`'umber of floors:
HVAC System Types (check all that apply) -. -~
Unit ventilator (single residence unit). _ •\Val1/window•AC unit (single residence unit)
Fan coil unit (single residence unit) Central ventilation system
Heat.pump unit (single residence unit) • - Passive shaft/duct ..
Oiher•(desrn'be)
Location of outside air intake: •
Outside.air intake accessible for iinspection • •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: • r- 6.4 i l 19 qw•S s
Location: G
Access adequate for inspection of components: ry -
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 4 of total dust
(fiberglass) depth) depth (Y/ ) loading
(flexible connector)
(double walled)
Outside air intake louvers, grates
and/or screens .
Outside air duct
Outside air dampers)
Return air grille ••
Return ait plenum ..
Filter rack
Filter media •
Coils (evaporator) .
Blower assembly
Condensate drain pan .
in-line electrical resistance strip . .
heaters (in supply ducts .
connected to unit ventilators) '
Fire dampers .
Turning vanes
Supply.air_plenum_or_supply duct .
Supply air plenum or supply duct .
liner
Supplyair diffuser . •
2.1 Ventilators, wall air conditioning units and window air conditioning units in common spaces
(coat.)
NYC-WTC 000135341
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000135341Source: NYC Law Department, mirrored locally