Block: 77 Residential 0 Commerci Name of Building:
Lot: Mix UseD Other .
# of Stories: AKA's:
Building Own r artageme t: Telephone Number: ( )
Name: 5 q \P\o~-L e v w~ FAX:
Address:
On Site Contact: -1
Name: Telephone Number: 242 Z 2' >c ) v
Building Owner Management jctivlties
Interior Survey Performed j Yes 0 No
Exterior Survey Perfo ed [2'Yes D No
General Clean Up es ❑ No Locations:
ACM Clean Up ❑ Yes.No Locations:
Air Monitoring D Yes D No Locations:
Copies of All Reports and Data Requested 9 Yes
Visual Inspection Results:
Facade:
Ins ected Debris
North 0 N/A Yes 0 No 0 No Visible/Fine Layer %: to 1" 9> 1"
South 0 N/A i es 0 No ❑ No Visible/Fine Layer % to 1" ❑ > 1"
East 0 N/A Yes 0 No 0 No Visible/Fine Layer a to 1" 9> 1"
West ❑ N/A es ❑ No ❑ No Visible/Fine Layer : to 1" ❑ > 1"
Facade Description:
Roof
Debris: No Visible /Fine Layer .D'/ to 1"
Description:
Setbacks N/A ❑
Floor. Debris: 0 No Visible/Fine Layer 0'/a to 1" 0> 1"
Floor. Debris: D No Visible/Fine Layer ❑'/a to 1" ❑ >V
Floor: Debris: 0 No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ Ya to 1" ❑ > 1"
Floor: Debris: D No Visible/Fine Layer ❑ .4 to V ❑ > 1"