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WTC Visual Survey Form BO 101 a9 cod
Premise Address: I Kas,5,3(-i S+ree
Block: Residential 0 Commercial El Name of Building:
Lot: Mix Use ❑ Other El
# 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 ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested El Yes
visual inspection Kesults:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/to1" 0>1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" 0>1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑YZto1" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1"
Facade Description: % _ _
Roof
Debris: ❑ No Visible /Fine Layer ❑ % to 1" 0>1"
Description:
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer fjl Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer E YZ to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer I Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer l Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer Y: to 1" ❑ > 1"
Comments
Date: c: / oP 0 /2002 Inspection by: Name: / \P Agency: DE P
Name: Agency:
M
NYC-WTC 000099522
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000099522Source: NYC Law Department, mirrored locally
Joint memorandum from NYC DEP and DOH advising building owners on post-9/11 maintenance, re-occupancy issues, and hazardous material assessments including asbestos.