WTC Visual Survey Form B W*I0 0110q'
Premise Address:
Block: Residential Commercial Name of Building:
Lot: 013 Mix Use Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: W i T K-o FAX:( )
Address:
On Site Co ct:
Name: Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed [des ❑ No
Exterior Survey Perfo ed [ 'Yes ❑ No
f
General Clean Up Yes ❑ No Locations:
ACM Clean Up U.YesJNo Locations:
Air Monitoring Yes ❑ No Locations:
Copies of All Reports and Data Requests Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer to 1"
❑'/z ❑ > 1"
South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'h to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑ % to 1" ❑ > 1"
Facade Description: