WTC building facade asbestos inspection form

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:LI`3 L I- oHt~l ar Z 61 Block: Residential Commercial E Name of Building: Lot: Mix Use ❑ Other ❑ # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: ( ) Address: On Site Contact: Name: Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No. General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested ❑ Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0Y2to1" ❑>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" O>1 East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1 - West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer [:]'/ to 1" 0>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine La yer ' ❑/to1 " •1 0 >1" .1 ;.-L—,4 . Description:

Setbacks N/A ❑ Floor: 9.! Debris: ❑ No Visible/Fine Layer 6 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ('❑ Y2 to 1" ❑ > 1" Floor: • Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 '/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments

Date: _Z/ I 002 Inspection Team: Agency: C - Name: Agency: ENTERED►

NYC-WTC 000092937