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Document / 3 pages

DEP no-referral intake form, 3 pages, undated

Machine-extracted title · confidence 95%

Three-page Environmental Protection Department no-referral form capturing operator information and referral status.

NYC-WTC_000147181–000147183

Folder label: “DEP No REFERRALS/1 No Referrals ( 2-2 )

Page image
Scanned page image, NYC-WTC_000147181
OCR text

OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document

n n«e: i/Z/sfinn^ 1^^^ Name of Operator hikTu/i- Category: (circle one)

Environment Health Indoor Air

Specific Contaminant School Other

lAil/ittAi~/n CaTjii) I'J^'-U cjjjldt^ljnAn fiAc 6// /yQ _

^SSZzSZSZZZ a y) ■_____________________________ __

0 /

First Name: Pll Last Namei, _____________ ___ ------- Pll Address 1:. 0^4 dWAMn Apt

Address 2: ________ _______________________________ Borough:

-c^^sUX City. State:. n7 Zip:

Phone #1 Pll n/- *13.71. Follow op: •f/nb Referral/Follow-Up Needed? (circle one) NO

Referral Agency/Organization:

DEP Reference # _ _______________________________ ‘_________

6fy<4JtihS ft- Th’ HA. J

MfT/4-^C J, UtXiwX u NYC-VVTC_000147181

OCR can misread numbers and units. Confirm readings against the page image before using them.

NYC-WTC_000147181Source: NYC Law Department, mirrored locally

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