WTC Visual Survey Form RN I OO 127S
Premise Address:
Ia0 aS a &Free~-
Block: Z Residential 0 Commercial Name of Building:
Lot: 27 Mix UseD 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 0 No
Exterior Survey Performed ❑ Yes 0 No
General Clean Up ❑ Yes 0 No Locations:
ACM Clean Up 0 Yes 0 No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected bris
North ON/A ❑YesDNo No Visible/Fine Layer 0'/ to 1" 0>1'
South ❑ N/A ❑ Yes 0 No No Visible/Fine Layer ❑%to1" 0>1"
East O N/A ❑ Yes D No No Visible/Fine Layer ❑%to1" 0>1"
West 0N/A ❑Yes❑No No Visible/Fine Layer ❑ % to 1" 0>1"
Facade Description:
Roof
Debris: 0 No Visible /Fine Layer % to 1" 0> 1"
Description: . . _-
Setbacks N/A ❑
Floor. Debris: 0 No Visible/Fine Layer 0 Y2 to 1"
Floor. 0> 1 "
Debris: 0 No Visible/Fine Layer ❑ V 10 1' 0> 1"
Floor Debris: 0 No Visible/Fine Layer ❑ V to V 0> 1"
Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: 0 No Visible/Fine Layer 0 V to V 0> 1"
Comments
Checklist form documenting building characteristics, facade visual inspection results, and asbestos presence assessment at 196 Broadway for post-9/11 environmental evaluation.