Block: Resi ential p Com a ci N e o Bul ng-
Lot: Mix Use p Other
# of Stories: I AKA's: l W
---------------------------------------_.
Building Owner anage Telephone Number. (
Name: ~~o - ~ FAX: P11
Address:
On Site Contact: ~c .-..v- J i
Name: - - ir' ~ ssô, Telephone Number: Z1 L 2'3 3 G 1 (,
Building Owner Management ActivIties
Interior Survey Performed Ses ❑ No
Exterior Survey Performed Yes ❑ No
General Clean Up Yes U No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Re uested es
Visual Inspection Results:
Facade:
jin cted De ris
North ❑ N/A s ❑ No No Visible/Fine Layer ❑'/z to 1" 0>1"
South ❑ N/A s ❑ No o Visible/Fine Layer ❑ Y to 1" 0>1"
East ❑ N/A s ❑ No o Visible/Fine Layer ❑ Y2 to 1" 0>1"
West ❑ N/A s ❑ No No Visible/Fine Layer ❑ Ya to 1" 0>1"
Facade Description:
Roof
Debris: No Visible /Fine Layer ❑ % to 1" ❑ > 1"
Descriptio .
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" F]> 1"
Floor. Debris: ❑ No Visible/Fine Layer 0 Y to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑Y to 1" ❑ > 1"