Block: I Residential Commercial Name of Building:
Lot: Mix Use Other
# of Stories: 3 1 AKA's:
Building Owner/ anag ent Telephone Number. (,Y ) LL'ç--
Name: -L(- ` FAX: -~
Address:
On Site Contact:
Name: ('A'+ - M -k— Telephone Number. ('Y11-) (cC
Building Owner Management Activities
Interior Survey Performed Ryes ❑ No
Exterior Survey Performed Yes ❑ No
General Clean Up i2Yes ❑ No Locations:
ACM Clean Up 0 Yes ❑ No Locations:
Air Monitoring ' -Yes ❑ No Locations:
Copies of All Reports and Data Re uested es
Visual Inspection Results:
Facade:
Inspected Debris
North /A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
South /A ❑ Yes ❑ No ElNo Visible/Fine Layer 0%to 1" ❑ > 1"
East N/A ❑ Yes ❑ No ElNo Visible/Fine Layer ❑ % to 1" ❑ > 1"
West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" a> 1"
Facade Descri tion:
Lro.7t ' 4t