HVAC monitoring addendum to scope of work, August 2002

NYC 9/11 Public Portal Document

VENTILATION SYSTEM EVALUATION FORM Part 1.0 General Information Date of Evaluation: I Building contact name and phone:

Evaluation Team (list name and affiliation): (Environmental Professional) (HVAC/Electrical Professional) (Sheet Metal Professional) Building Address: Type of Facility (check all that apply): r~l Residential Q Multi-use □ Other (describe) Number of residential units: Number of floors: gVAC System Types (check all that apply) r 1 Unit ventilator (single residence unit) □ Wall/window AC unit (single residence unit) □ Fan coil unit (single residence unit) r~l Central ventilation system □ Heat pump unit (single residence unit) □ Passive shaft/duct □ Other (describe) Location of outside air intake: Outside air intake accessible for inspection Y N (explain) Part 2.0 Checklists 2.1 Ventilators, wall air conditioning units and window air conditioning units in conunon spaces Ventilation System Identification: Location: Access adequate for inspection of components: Dust/Dirt / Debris Suspect WTC-Related Dust System Component Substrate Material (sheet metal wrapped) Light Heavy Estimate % of total dust Present? System Components (sheet metal lined) None (<1/16 inch (^1/16 inch (Y/N) loading (fiberglass) depth) dq)th (flexible connector) (double walled) Outside air intake louvers, grates and/or screens______________ Outside air duct Outside air damper(s) Return air grille Return air plenum Filter rack Filter media Coils (evaporator) Blower assembly Condensate drain pan In-line electrical resistance strip heaters (in supply ducts connected to unit ventilators) Fire dampers Turning vanes Supply air plenum or supply duct Supply air plenum or supply duct UnCT_______________________ Supply air diffuser

2.1 Ventilators, wall air conditioning units and window air conditioning units in conunon spaces (cont)

NYC-WTC_000163409