NYC 9/11 Public Portal Document
Name of Operator_' ) 0.4 &L t Date: 3L Time• oZ I dl Ph.
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Ca (circle one)
Envirom~lient Cleaning Health Indoor Air
Specific Contaminant School Old WTC Other
4- 90
Answer: / - ' 2 o , "l
,A)E4- /~r N~~`-' /~~ , 2i A i2
fi t,- 41 q1) z; cI / _~
First Name 1 11
Address 1: 'C 1 P - _._._._._._._._._._._._._._._
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Address 2: _T 1hU [ Borough: I ( 1 0h
City State: Zip:
PII ._._._._._._._._.a_._._._., Phone #2 e! 3 r] a3
Phone #1-._._._._._._._._._._._._._._._._,_._._._._._._._._._._._._._.
Follow n: g G 344 lb
Referral/Follow-Up Needed? (circle one) YES NO
Referral Agency/Organization: Q
DEP Reference # 4 °~•` tr
NYC-WTC 000146939
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