--i 1/Tr`_ Vicii l Siirvpv Form I I.2-4 )
Premise Address: y3
N
OL
Block: Residential D CommercialU Name of Building:
Lot: Mix Use 0 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 ❑ 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 Kesuits:
Facade:
Inspected Debris
North ❑N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑%tol" 0>1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1"
Facade Description: nn
Roof
Debris: ❑ No Visible /Fine Layer ❑'/ to "1
Description:
t I
Setbacks N/A
Floor.
I Debris: ❑ No Visible/Fine Layer 0
Visible/Fine Layer 0
to 1"
to 1"
❑ > 1"
❑ > 1"
Floor. Debris: ❑ No
Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
DEP inspection form for 50 Broadway documenting building characteristics, facade conditions, and asbestos-containing material survey across multiple building faces.
Checklist form documenting building characteristics, facade visual inspection results, and asbestos presence assessment at 196 Broadway for post-9/11 environmental evaluation.