WTC mixed-use building inspection form

NYC 9/11 Public Portal Document

•' ' WTC Visual Survey Form £ Q AAia#r?1r. Premise Address:

Block: Residential Commercia1 Name of Building: Lot: Mix Use 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 Q No Exterior Survey Performed a Yes 8 No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data RequestedIJ Yes Visual inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No 0 No Visible/Fine Layer 916 to 1' 9>1' South 9 N/A 9 Yes 0 No East West ❑ N/A ❑ N/A BYesoNo D Yes ❑ No O No Visible/Fine Layer 916 to 1' No Visible/Fine Layer h to 1' ❑ No Visible/Fine Layer 9161o1' 0>1' > 1'

0>1' Facade Description:

Roof

Debris: No Visible /Fine Layer .D %tor 9>1' Description:

Setbacks N/A D Floor____ Floor__ Debris: ❑ No Visible/Fine Layer 916101' Debris: ❑ No Visible/Fine Layer ❑ % to 1' 9>11'. B2P Floor. Debris: 0 No Visible/Fine Layer ❑ % to V Floor Debris: Q No Visible/Fine Layer ❑ 1 to V ❑ > 1' 0>1' Floor. Debris: 0 No Visible/Fine Layer r] % to 1' 9>1' Comments

0 ,. Date- r•~- I - ~.. T.s.... --. ... V IIW. ---- Asm"Uy.

Name: Agency:

NYC-WTC 000099612