WTC inspection form for facade and setback assessment

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: M Block: Residential tEkl Commercial ❑ Name of Building: Lot: Mix Use 0 Other ❑ # of Stories: i_ AKA's: Building OwnerIManagenent Telephone Number: ( ) Name: C o-i.j S FAX: ) Address: On Site Contact: Name: " ' . ( V5 -t 1,W u 'Telephone Number: ()-12) )- -7 Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ / to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑V to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" E> 1" West ❑ NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" j>1" Facade Description:

Roof

Debris: © No Visible /Fine Layer ❑'/z to 1" ❑ > 1" Description:

Setbacks N/A Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1"

Comments

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NYC-WTC 000100533