WTC Visual Survey Form l3m t oao $3
Premise Address:
L41 Nassau S4ree-~
Block: (p44 Residential
Li Commercial D Name of Building:
Lot: ) Mix Use 0 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 0 Yes 0 No
General Clean Up 0 Yes 0 No Locations:
ACM Clean Up 0 Yes 0 No Locations:
Air Monitoring 0 Yes 0 No Locations:
Copies of All Reports and Data Requested 0 Yes
visual inspection Results:
Facade:
Inspected Debris
North 0 N/A ❑Yes 0 No 0 No Visible/Fine Layer jjj 34 to 1" ❑ > 1"
South ❑ N/A 0 Yes 0 No 0 No Visible/Fine Layer '/ to? 0>?
East 0 N/A 0 Yes 0 No ❑ No Visible/Fine Layer Y2 to 1' 0>?
West 0 N/A ❑ Yes 0 No ❑ No Visible/Fine Layer 1%tol"
Facade Description: 0 > 1"
Roof
Debris: Ig o Visible /Fine Layer to 1" 0>?
Description:
Setbacks N/A ❑
Floor Debris: 0 No Visible/Fine Layer 034 to? 0>?
Floor Debris: 0 No Visible/Fine Layer 034 to? 0>1'
Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" 0>1"
Floor Debris: 0 No Visible/Fine Layer ❑ % to? 0>1"
Floor Debris: 0 No Visible/Fine Layer ❑ % to 1" 0> 1*
Comments
Date: %L/13 12002 Inspection by: Name: AP Agency: DEP
Name: Agency:
NYC-WTC 000099789
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000099789Source: NYC Law Department, mirrored locally