NYC 9/11 Public Portal Document
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Name of Operator JA ark b Rt Date: 3 ! ' -Time: 11;s-i. 2cS
Category: (circle one)
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Environment
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Cleaning
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Specific Contaminant School Other
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Ouestion:
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Comments:
First Name:
Address 1: 15 SO E c h t &fig A.!!.!
Address 2:
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City Y'JL. C State: Y Zip:
Phone Phone #2 ( )
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Follow up:
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Referral/Follow-Up Needed? (circle one) YES NO
Referral Agency/Organization: ~. `~. I
NYC-WTC 000146980
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