NYC 9/11 Public Portal Document
w i c visual survey Farm C L. , , ,- M
Premise Address:
ISO N A5S (U)Mr But')
Block: 100 Residential Commercial p Name of Building:
Lot: Mix Use 0 Other
# of Stories: 2b AKA's: 2-6 sprwc~ s -r
Building Owner/Management: Telephone Number: (21z )sic
Name: FAX:
Address:
On Site Contact
Name: ,e, 9- 1 Telephone Number.
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up 0 Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
Visual inspection KesuIts:
Facade:
Inspected Debris
North ❑ N/A IYesDNo No Visible/Fine Layer ❑vzto 1" D> 1"
South ❑ N/A Yes ❑ No No Visible/Fine Layer 0'/ to 1" 0>10
East ❑ N/A E JYesDNo J I Visible/Fine Layer
No D'/tol" 0>1"
West ❑ N/A ® Yes Q No No Visible/Fine Layer ❑%atol" 0>1"
Facade Description:
Roof
Debris: (M No Visible /Fine Layer ❑'/to1"'' -- 0>1"
Description:
Setbacks N/A IZI
Floor Debris: 0 No Visible/Fine Layer ❑'l:to 1" ❑ > 1"
Floor. Debris: 0 No Visible/Fine Layer 0 % to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0 h to 1" ❑ > 1"
Floor Debris: 0 No Visible/Fine Layer ❑ h 10 10 ❑ > 1"