NYC 9/11 Public Portal Document
WTC Visual Survey Form /0- IS~7
Premise Address: ~ *cc u r;
i
Block: t `U Resident mme Name of Building:
Lot: 0245 Mix UseD OtherD
g of Stories: AKA's:3o - l o Cr o\c ST 35 ' 3~ ~fEJtACF 5-r 3 - aH4gg(
Building Owner/Management T lephone Number ( ) / - Gw
Name:-o C/o 4uo i t , tz T FAX:
Address: o i C)
On Site Contact:
Name: ' ' ' ~ ~~~~ I Telephone Number
Building Owner Management Ac sties
Interior Survey Performed
Exterior Survey Performed
General Clean Up
8 8
Yes No
Yes No
Yes No Locations:
ACM Clean Up g Yes No Locations:
Air Monitoring D Yes D No Locations:
Copies of All Reports and Data Requested fl Yes
Visual Inspection Results:
Facade:
Ins cted Debris
H
North L3 N/A es H No No Visible/Fine Layer %to1' 1'
South D N/A a -Yes No o Visible/Fine Layer % to 1' > 1'
East N/A es No No Visible/Fine Layer i4 to 1' > 1'
West N/A J 'es No Visible/Fine Layer %tolu >1 '
Facade Description:
Roof
Debris: /Fine Layer .D 3+4 to V D > 1'
Description:
Setbacks P1/AD
Floor___ Debris: No Visible/Fine Layer % to?
Floor____ Debris: No Visible/Fine Layer 36 to 1'
Floor Debris: No Visible/Fine Layer % to 1'
Floor.___ Debris: No Visible/Fine Layer % to 1'
Floor___ Debris: No Visible/Fine Layer % to?
Comments