NYC 9/11 Public Portal Document
'fl
I
SW<S?SWSpWsK~H!i i
I (U—- ■ ,■
Date: Time:
: •■ - ‘ ' '- -k
*' f
pwrcH-
Mikl 0^/ Cleaning Health
\ , . '■ ' (.. .* ti
a tool Other-r
'
*. I U *4 w _
bjc biiUiV
tvcS rwb
'TbGp flp Ci^Atk c4" o U cUx)^^ tv << 1L fh K
™ T?gp cvm MIU-c,t>
Bi?T lUUh^^u) ”
-^iCftvH MAyi-l I
flki^AV d t I Al iV^^Vy/ £^C
Caller Information;
First Name: L - V !! J Last Name: i PH
Address 1: ii1 Apt lv {
Address 2: SdvtoKWi
City____ KJV State; KiV Zip;
Phone #1 i Pll Phone #2 ()
“XT^
Follow up;
Referral/Follow-Up Needed? (circle one)
'^1
YES ; NO V
Referral Agency/Organization: VDiE^ 0^/-
IfcO 6*\oAWjAY
'i<v- (> (■tfPM 212 - ■^M‘1 -- Zt t-SM.
Il'ry'U
NYC-WTC_000147889
OCR can misread numbers and units. Confirm readings against the page image before using them.