DEP Health or Cleaning Referral Form, WTC Site

NYC 9/11 Public Portal Document

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ee.17 Jundlon S►vd. Service Request Inspection Detail Caroms, NY 11388 (71e)DEr=-HEu Pax (Ti b)55.4O

Fors Date 0312812002 06;18 PM Submitted By Page I

Servlli a 0 424621 Problem BWTCH WTC RELATED (MOT LINE) Address BROADWAY I 10007 Cross $t n is JOHN ST 1

Cempese Otwetlen Suitdlne 1D Block Lot CMttD 101

man Arm Distrtot Sub-Area '101 Psi *l

0 or Cans 1 Duration of Call 0000 Cell D*tu 0312512002 1423 Taken By ._.psi_:_: GERENA, TASHA } Respeesibllltp SHZ SANHAZMAT (AIR,NOISE,HAZAAAT) Priority Scheduled Dace $fartDais Inspector inspvotlon D* Due Date ❑ No Work Ordms Rsqulrsd RwalutIon Dude Reeohmlen Date Asset la'ip bwatlaa ❑ Customer CenAect Req Ara I1MP Days 0 Budget M Ara Insp Hre 0 Arg Insp Mlnu 0

Pmwgm c{sntmenta THIS CObtPU mT WAS FORWAROED TONE ASBESTOS uNCT FOR APPROPRIATE ACTION. _ ,~: :,;; :,,. :via. • _ ..• ~ Inntat ,•ti •. ..}...... :M.:" {:f. t t . ... a :.:i t.z C. :i , uz~l i:'f'a:'.t ya :;:::.w':a1a 1.a' 1''..::ua!ls:ti t •.:: Nb r'ar ie,

Two Lest Name MOYERS PUst Name, Mt SCOTT AddnM

City, stetstProrhlcs, VPIPC O Foreign Wp Do* 03125 214.23 Qty Phone (lt1Z)S1$r3021 x ttrenln9 Phone Rshronaa S

Caller Commence EASY STRIPE SHOE STORE BROADWAY fl JOHN ST HAS NOT UEEN { , r~,. ., S:' • I''K •,t~4C. 'q„•'c H:t`!1'Ttz: {d4tt~{ {.klW' r1' i eg i:j.tutJ~•~`''!—,•ih8i'!e}~' ip "~

There we no work ordaf0 for M a service number

Mqt " ►s pp ,ry },}. ' .,ygyq p•4+L~P,J~:i.JL16t19 .. II,l~3• ,,

Thom am no assets I

No Unked Requests for uuc Service Request btepectlan

Z0 d trti : 81 Z0, SZ J'W ttb'Z£S6S8WZ: X'3 33X3 MPFUJJH d3Q JAN NYC-WTC 000147053