WTC Visual Survey Form
Premise Address:
73
Block: Residential ❑ Commercial JJ Name of Building:
Lot: Mix Use ❑ Other ❑
#of Stories: AKA's: ' 7 ) t' ' "
Building Owner/Management: elephone Number: ( )
Name: FAX: ( )
Address:
On Site Contact:
Name: Telephone Number: ( )
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 E]'/ to l" 0>1"
South ❑ N/A 0 Yes ❑ No 0 No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0114t01" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Facade Description:
DEP inspection form recording building details and facade conditions (north, south, east, west sides) with damage extent measurements and ACM documentation.
3 shared non-person entities · 1 shared topics · Same agency, volume and box · similarity 0.982
Standardized inspection form documenting building characteristics, asbestos materials assessment, and visual inspection results for facade debris on all four sides.