NYC 9/11 Public Portal Document
****DRAFT Version 10, October 29, 2001****
7. Is your HVAC (heating/AC) system in your apartment/condominium (vs. a bldg-controlled
system)?
Yes No
TTYES, whaTType of filter do you have (describe)?
Name
Size
Type
What was the date of the last filter change?
Have you been using your HVAC system since the WTC event?
Yes No
ITYES, is it recirculating air or drawing fi-om the outside?
Has the HVAC system been service or cleaned since the WTC event?
Yes No
Have the ducts been cleaned since the WTC event?
Yes No
TfYES, provide date(s) of cleaning
8. Do you or does anyone who lives here, or visits frequently, smoke tobacco'products?
Yes No
9. During this air and dust sampling, did you:
Cook on the stove
Yes No
If yes, was the exhaust fan on
Yes No
Have a fire in your fireplace
Yes No
Smoke cigarettes or other tobacco
Yes No
Clean or vacuum
Yes No
Tfyes, descflBS"
Bum candles, incense, etc.
Yes No
Page 12 of
NYC-WTC_000153231
OCR can misread numbers and units. Confirm readings against the page image before using them.