Investigation of Complaint Report Form, n.d.

NYC 9/11 Public Portal Document

A-17 (3/88) H1-880294-R25 INVESTIGATION OF COMPLAINT REPORT □ INTERIM REPORT B-FWAL REPORT DIV. BATT. CO. D.O. COMPLAINT COMPLAINT A.M. NUMBER DATE REC’D / -^/^^TIME RM.

HOW RECEIVED: □VERBAL □card-letter □ BUR. OF F. P. Q01§P. □ OTHER 7 RORO ZIP CODE PREMISES LOCATION

Bldg. Owner Name. Type of Occupancy/ Bldg.

Bldg. Agent Construction Height

Occupant Name of Officer (If Corp.) Title

Mailing Address Boro. Zip Code

Complainant’s Name Telephone.

Complainant's Address Boro. Zip Code

ITEM FILL IN ROOM/ NO. ITEM NO. NATURE OF COMPLAINT FLOOR LOCATION

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 FIS 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

m>0-CAUSE FOR ACTION TAKEN: □V.O. ISSUED □A-S □ special report □summons ISSUED COMPLAINT REMARKS:________________ ________________________________________________________________________

___________

INVESTIGATED BY: SIGNED RANK UNIT DATE

OFFICER ON DUTY RANK UNIT ,,7/EZ^.. . group

BATTALION CHIEF BATT. GROUP DATE I__ L DEPUTY CHIEF DIV. GROUP DATE 1__ L ENTRIES: LEGIBLY PRINTED, USING BALL POINT PEN OR TYPEWRITER

NYC-WTC_000169180