NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address: "'~
Blopk: .a Residential j J Commercial Name of Building:
Lot: Mix Use ❑ Other ❑
# of Stories: ' AKA's:
Building Owner/Management: Telephone Number: (,,z t 2-) f(, 3j k~
Name: ' ► c -i2 t a ) Ci2'i t S FAX: ( )
Address: i ' M e.4-i >C~- z c
On Site Contact:
Name: Telephone Number: ( 2t2.) S J 33-4
Building Owner Management Activities
Interior Survey Performed ['Yes ❑ No
Exterior Survey Performed [a-Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring DYes ❑ No Locations:
O 1Z ë. -t Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ErYes ❑ No ❑ No Visible/Fine Layer [J ½ to 1" ❑ > 1"
South ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
East ❑ N/A D Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
West ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Facade Description:
//~4 i D 2fyt 5, c
Roof
Debris: ❑ No Visible /Fine Layer ❑ % to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor: tK Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1" / '-;
Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" E1> 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
Comments -„
CMG Si ' 2' ls'-P t c. i I, ~txtGc $ Air ,/'owt
I . 6 4cU42et-f 5 l Gt *fL i,\4 Sr f-1. .- friP
Date: ;' ! / -S /2002 Inspection Team: Name: '/-'( /" Agency: A —
Name: , 1; Agency: r)(
NYC-WTC 000100112
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