WTC Visual Survey Form
Premise Address:
t
-f
Block: Residential El Commercial El 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 0 No
Exterior Survey Performed ❑ Yes 0 No
General Clean Up ❑ Yes 0 No Locations:
ACM Clean Up ❑ Yes 0 No Locations:
Air Monitoring 0 Yes 0 No Locations:
Copies of All Reports and Data Requested Dyes
visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes 0 No ❑ No Visible/Fine Layer [] % to 1" 0>1"
South ❑ N/A ® Yes 0 No ❑ No Visible/Fine Layer E] Y to-1" 0>1"
East ❑ N/A ❑ Yes 0 No ❑ No Visible/Fine Layer 0'/ to 1" 0>1"
West ❑ N/A ❑ Yes 0 No ❑ No Visible/Fine Layer E]% to 1" 0>1"
Facade Description:
Roof
l-1
Debris: 0 No Visible /Fine yer Ya to I •1 -~'`' 0 > 1" 1
i t w4t: n •
Description: I ti+sc'c sc r ►—n-c n o h orc -
Setbacks N/A R
Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: No Visible/Fine Layer ❑V to? ❑ > 1"
Floor: Debris: BNoVisible/Fine Layer ❑ 34 to 1" ❑ > 1"
Floor. Debris: 0 No Visible/Fine Layer ❑'h to 1" 0> 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ 34 to 1" 0> 1"
Comments
r + -,7 nnnn I......e..3..... ~r u........
Name: hii4r a Y. Agency:
NYC-WTC-000100295
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000100295Source: NYC Law Department, mirrored locally
Department of Environmental Protection letter dated February 12, 2002, requesting building owners to submit environmental hazard assessments for 54 Warren Street.