NYC 9/11 Public Portal Document
A-17 (3/88) H,-8B0294-R25 INVESTIGATION OF COMPLAINT REPORT □ INTERIM REPORT
B-RNAL REPORT
DIV. BATT. CO. D.O.
COMPLAINT zj-j COMPLAINT
/ NUMBER V 4: O__________ DATEREC’D
HOW RECEIVED: □VERBAL □card-letter □ bur. of f.p. &0TSP. □other
PREMISES LOCATION ___ f bqrq zIP CODE /
Type of Occupancy/Bldg. <2 ~
Bldg. Owner Name.
Construction Height ^2_____ Area
Bldg. Agent
Name of Officer (If Corp.) 212______ Title /161' /
Occupant
Mailing Address Boro. Zip Code
Complainant’s Name Telephone.
Complainant’s Address Boro. Zip Code
ITEM FILL IN ROOM/
NATURE OF COMPLAINT FLOOR LOCATION
NO. ITEM NO.
1 RUBBISH — COMBUSTIBLE_______________________
2 CERTIFICATE OF FITNESS REQUIREMENTS__________
3 INCINERATOR CLOGGED/DEFECTIVE_______________
4 DEFECTIVE OIL BURNER____________ _____________
5 REQUIRED SELF CLOSING DOOR — DEFECTS_______
6 EXITS — BULKHEAD DOORS LOCKED______________
7 BLOCKED — OBSTRUCTED EXITS/HALLS___________
8 FIRE ESCAPE OBSTRUCTIONS
9 DEFECTIVE ELECTRICAL FIXTURES/OUTLETS/WIRING
10 WATER LEAKS (NEAR ELECTRIC WIRING/FIXTURES)
11 VACANT BUILDING (BOARD UP)____________________
12 LIGHTING IN HALLWAY/STAIRS
13 ILLEGAL OCCUPANCY
r7T,N0-CAUSE FOR
ACTION TAKEN: □V.O. ISSUED □A-S □SPECIAL REPORT □SUMMONS ISSUED
‘^COMPLAINT
REMARKS:_________________________________________________________________________________________
INVESTIGATED BY:
UNIT 2
SIGNED RANK
date
3 /7 1^^
UNIT 22^
OFFICER ON DUTY _ RANK GROUP
BATTALION CHIEF BATT. GROUP. DATE //
DEPUTY CHIEF DIV.. GROUP DATE i/
ENTRIES: LEGIBLY PRINTED, USING BALL POINT PEN OR TYPEWRITER
NYC-WTC_000166012
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