Bln±ck: Residential Commercial jJ Name of Building:
Lo',» a1Y 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 Q No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes Q No Locations:
ACM Clean Up 0 Yes Q No Locations:
Air Monitoring Q Yes Q No Locations:
Copies of All Reports and Data Requested D Yes
Visual Inspection Results:
Facade:
Inspected Debris
North Q N/A Q YesQNo ❑ No Visible/Fine Layer ❑34to1' 0>1•
South ❑N/A QYesQNo ❑ No Visible/Fine Layer ❑%to1 0>10
East ❑ N/A ❑ YesQNo ❑ No Visible/Fine Layer ❑%to l' 0>1
West ❑ N/A Q YesQNo ❑ No Visible/Fine Layer 034t01' 0>?
Facade Description: ( U
Roof
Debris: No Visible !Fine Layer .934 to? 0>1.
Description:
Setbacks N/A
Floor. Debns: Q No Visible/Fine Layer ❑ 3% to r ❑ > 1'
Floor: Debris: Q No Visible/Fine Layer h to 1' 0>1.
Floor____ Debris: Q No Visible/Fine Layer 34 to 1' ❑ > 1'
Floor. Debris: Q No Visible/Fine Layer % to 1' ❑ > 1'
Floor.____ Debris: Q No Visible/Fine Layer ❑ % to 1' Q > 1'
Comments
NYC-WTC 000110108
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000110108Source: NYC Law Department, mirrored locally