DEP referral form for Old WTC site with handwritten notes

NYC 9/11 Public Portal Document

Name of Operator ^>4 Date: *3 hrio X Time: fjl Category; (circle one)

Environment Cleaning Health Indoor Air

Specific Contaminant School OldWTC (Sd^

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CtiM ?{9Q^ <m1A£a^A S-M ____________________

Caller InformaftoiQi PH --------------- Last'Name: First Name: PH Address 1:

Address 2: Borough:

City___ State: Zip:

Phone#!. PH Phone #2 ()

Follow up;

Referral/Follow-Up Needed? (circle one) NO

Referral Agency/Organization:

DEP Reference #

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NYC-WTC_000146965