NYC 9/11 Public Portal Document
Mime of Operators\„f b ; nCL Date:J 2Z Time: !
Category: (circle one)
Environment leanin Health Indoor Air
Specific Contaminant School Old WTC Other
Ouestion: n 1. _ , . ., _ rr , i. _ 10
Comments:
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Caller L,formation• ; ---------------------- -----------------------------,
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First Name: Last N~ II
Address 1: _21 s 4ie.e I Apt
Address 2: Borough:
City State: . Zip:
P II P one .l ' 7 p
1 5553
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Referral/Follow-Up Needed? (circle one) S , NO
Referral Agency/Organization: i)T f> C L~
DEP Reference # J
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NYC-WTC 000146963
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