NYC 9/11 Public Portal Document
WHERE APPLICABLE - ANSWER ALE QUESTIONS
WHERE NOT APPLICABLE - ANSWER "NOT APPLICABLE" USING LETTERS "N-A."
LIST EACH ITEM NOT COMPLIED WITH ON EACH ORDER, BY STANDARD DATE VIOLATION ORDER WAS SERVED
FORM ORDER NUMBER ONLY, AS OF DATE OF EVIDENCE RE SUMMONS
BY WHOM VIOLATION ORDER WAS SERVED
TO WHOM VIOLATION ORDER WAS PHYSICALLY GIVEN
STATE SPECIFIC AMOUNT. KIND ANO
CONDITION OF MATERIALS WHICH ARE
SUBJECT MATTER OF COMPLAINT.
N/A
SPECIFY AMOUNT OF RUBBISH
IN CUBIC FEET N/A
IS THERE A F.D. PERMIT NOW IN FORCE? Thi» must ba lillad in: DATE LAST PERMIT EXPIRED, IF ANT
YES IF YES AMOUNT OF annual FEE
NO. PERMIT NO S
SUBSTANCE FEE
LIST ALL OTHER SUBSTANCES OR APPLIANCES
S
REQUIRING A PERMIT THAT ARE ON PREMISES
WITHOUT A PERMIT . GIVE FEE THAT WOULD
N/A S
APPLY FOR THESE SUBSTANCES
N/A
$
STATE NATURE OF UNUSUAL HAZARD, IF ANY
PRESENT
N/A
N/A
GIVE DATES AND AMOUNTS OF PREVIOUS FINES
IF ANY, AGAINST PERSON SERVED SUMMONS
IF FOR SAME OFFENSE AS PRESENT SUMMONS, GIVE PARTICULARS N/A
IF FOR FAILURE TO COMPLY GIVE ORDER NOS. o
REMARKS:(liST UNUSUAL CIRCUMSTANCES AND/OR CONDITIONS)'.
NOTE: This form to he forwiirii.:d in DUPLICA TE , with single copy of order or orders artd stub of summons served attached.
examined by SERVED AND PREPARED BY
-z'
Rank Title Unit Ronk Titi. Unit
NYC-WTC_000166076
OCR can misread numbers and units. Confirm readings against the page image before using them.