NYC 9/11 Public Portal Document
SECTION 5. Information for samples taken from RESIDENTIAL UNIT 1.
A. Point of Contact for Residential Unit 1
Name_______________________
Address_____________________
Phone Number
The following questions describe the characteristics of the area the listed samples were taken from.
B. Location of Floor Above Ground Level Number (ground floor = 1, basement = B)
C. Type of Residential Area Sampled
_____ Living Room Bedroom
_____ Dining Room Den/Office
_____ Kitchen Bathroom
Hallway Other (please describe)
D. Are sample locations (with sample number) shown on map? Y N
E. Is dust visible in this area? Y N
F. Has area where sample was obtained been cleaned since WTC event? Y N Not
Sure
If yes:
Date of last cleaning Not
Sure
Who conducted cleaning?
____ Building owner
____ Tenant
____ Asbestos remediation contractor
____ Professional cleaning contractor
Private cleaning contractor
Name and Contact Information for Contractor:
G. How was this area cleaned?
____ Wet mopping
____ Dusting
____ Sweeping Broom Vacuum HEPA Vacuum
Carpet cleaner
Curtains Removed Cleaned Cleaned and
In Place Replaced
Furniture Removed Cleaned Cleaned and
In Place Replaced
SECTION 5. Information for samples taken from RESIDENTIAL UNIT 1 (continued)
H. How much dust was present in this area prior to cleaning?
Normal Slight Increase Moderate Increase Large Increase
Amount Over Normal Over Normal Over Normal
20
NYC-WTC_000164753
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