Block: Residenti Commercial 0 Name of Building:
Lot: ( Mix UseD Other
0 of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: FAX:
Address:
On Site Conta
Name: °' Telephone Number:
Building Owner Managerient tivities
Interior Survey Performed ❑ es ❑ 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 2 INJA ❑Yes❑No ❑ No Visible/Fine Layer ❑%atol" 0>1"
South ❑ N/A es❑No Visible/Fine Layer ❑ ato 1" 0>1"
East ❑ N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑Vato1" 0>1"
West ❑ N/A ❑files❑No No Visible/Fine Layer ❑V2to1" 0>1"
Facade Description:
Roof
Debris: Visible /Fine Layer ❑ Ya to 1" " 0>1"
Description:
Setbacks N/A 0
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑Va to 1" ❑ > 1"
Department of Environmental Protection WTC building inspection form for 30-story structure documenting facade inspection results, ACM sampling status, and building contact…