Please complete this form in accordance with instructions In the accompanying guidance document
Part l_0 (*pneral Tnfnrm*lion
Date of evaluation: ! 0 Building contact name and phone:
Evaluation team (list name and affiliation):
T°=., & q '' a« (Environmental professionai
(HVAC professional)
Building address: Type of Facility (check all that apply):
3Qo P qr y XResidential
nr~. w a L14- Multi-use
Other (describe)
Date of construction:
Number of residents units: Number of floors:
Prior inspection report/maintenance records available for review?:
NJ
Other comments
Ventilation system types (check all that apply and indicate total no. of units)
Central ventilation system Mechanical exhaust system
Est. no. of units Est. no. of units 1
Mechanical make-up air system Passive shaft/duct
Est. no. of units Est. no. of units
Other (describe)
I certify that to the best of my knowledge, the information and observations recorded on this
form
including all attachments are a true and accurate representation of site conditions.
Veiltil ilo i VAC) Evaluator' . Date
t, /, ..... .
. iflfo3
t art 2. a Visual Inspection Forms
Use the attached forms to document visual Inspections. Complete the forms In
accordance with
instructions in the accompanying guidancetdl~cument.
NYC-WTC 000135422
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000135422Source: 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.