NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
31
Block: Residential 0 Commercial j J Name of Building:
Lot: Mix Use J Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number: (, t 2-) c(~- 3 i g~
Name: t (GtLL~2 la<n3C(2; S FAX: ( )
Address: I y M e4-it)C-%,-4 iA-tJ
On Site Contact:
Name: * 'A(l) Sb1'~t =•2.4 T Telephone Number: ( 2t2-) 3fl 3 3
Building Owner Management Activities
Interior Survey Performed ['Yes ❑ No
Exterior Survey Performed [n-Yes ❑ No
General Clean Up 0 Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring [Yes ❑ No Locations:
vcyLiM - v+t., Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ["Yes ❑ No [5 No Visible/Fine Layer ❑ % to 1" ❑ > 1"
South ❑ N/A [3 Yes ❑ No ® No Visible/Fine Layer ❑ % to 1" 0>1"
East ❑ N/A [2 Yes ❑ No ® No Visible/Fine Layer ❑'/ to 1" 0>1"
West ❑ N/A Q Yes ❑ No ® No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Facade Description:
f !, c L ~. Aut lvl ft~c1—
Roof
Debris: 0No Visible /Fine Layer ❑ % to 1" ❑> 1"
Description:
Setbacks N/A ❑
Floor: ~gf Debris: ❑ No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1" / c
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/a to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
,Comments
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36
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Date: ,~ ,' I . S 12002 Inspection Team: Name: < <Y' "ft( L a Agency:
Name: i '-illy ' , Agency: t
J
NYC-WTC 000100125
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