WTC Visual Survey Form BN%1 100IO85.
Premise Address:
b~
Block: Residential 0 Commercial Name of Building:
Lot: ' Mix Use ❑ Other ❑
# of Stories: AKA's:
Building Owner/Management: tom}-e- - , Telephone Number: ( )
Name: c~aQ (~a.—dcc CQFAX:
Address:
On Site Contact: p
Name: - Yo-e_ o,-~~ Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed ( Yes ❑ No
Exterior Survey Performed des ❑ No
General Clean Up ❑ Yes No Locations:
ACM Clean Up ❑ Yes No Locations:
Air Monitoring DYesKjNo Locations:
Copies of All Reports and Data Requested I Yes
Visual Inspection Results:
Facade:
Inspected debris
North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'/2tol" 0>1"
South ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer 0Y2 to 1" ❑> 1"
East ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑'/%to l" ❑> 1"
West ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑ % to 1" ❑ >1"
Facade Description:
0 c _c.Q .s
Roof
Debris: No Visible /Fine'Layer ❑'/ to 1" ='"' ❑ > 1" •1
Description:
Setbacks N/A
Floor: Debris: ❑ No Visible/Fine Layer ❑'h to 1" ❑> 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'% to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
A Department of Environmental Protection letter advising on building maintenance and contamination assessment following the World Trade Center collapse.