WTC Visual Survey Form ,r te,+~iC'T'
Premise Address:
III t. ASSAU S-r izEE:T
Block: 90 Residential 0 Commercial EJ Name of Building:
Lot: i 6 Mix Use J Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number: (zit. ) 22r-9 395
Name: PI LADE B ROS. FAX:
Address:
On Site Contact:
.
Name: • wv A. Pt_u s Fl Telephone Number: (2 + 2 2g--4 232.
Building Owner Management Activities -
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring 0 Yes Q No Locations:
Copies of All Reports and Data Requested J Yes
Visual Inspection Results:
Facade: 5EE
Inspected Debris
North ❑ N/A ❑ Yes Q No ❑ No Visible/Fine Layer ❑Yto1" 0>1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'2 to 1" 0>1"
East ❑ N/A Yes D No ❑ No Visible/Fine Layer Q'/ to 1" 0>1"
West ❑ N/A Q Yes Q No ❑ No Visible/Fine Layer ❑Yto1" 0>1"
Facade Description:
AwNif 5 C.& tt V32JS. Ao\E5 oN %A Dc C.: S+A►►► is Car Is
I Roof
Debris:
Description:
❑ No Visible /Fine Layer 4V to 1" 0> 1"
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Doe: 06 / 10 12002 Inspection Team: Name: pA f A020. Agency: ►sic
Name: Agency:
i
NYC-WTC 000099088
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000099088Source: NYC Law Department, mirrored locally
Checklist form documenting building characteristics, facade visual inspection results, and asbestos presence assessment at 196 Broadway for post-9/11 environmental evaluation.