Block: Re tialD Comr N e o Bui n
Lot: Mix Use J J Other j
# of Stories: I AKA's: Gi W
Building Owner anage ent: t --"--------------------------------------
Telephone Number: (
Name: \ o - u ti '-" FAX: P11
Address: ---- ------- --------
On Site Contact: c f Q,..
a -„~
Name: \jk K \ Vk y Telephone Number: (ZI L)23 ~, G 1 (,
Building Owner Management 4ctivities
Interior Survey Performed es ❑ No
Exterior Survey Perfo d Yes ❑ No
General Clean Up Yes o 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:
lnpected De ris
North ❑ N/A Yes ❑ No No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
South ❑ N/A Ves ❑ No o Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
East ❑ N/A 7Yes ❑ No No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
West ❑ N/A fl yes ❑ No No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Facade Description:
Roof
Debris: No Visible /Fine Layer [] % to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0
V to 1" ❑ > 1"
Floor: Debris: []No Visible/Fine Layer ❑'/ to 1" ❑ > 1"