WTC Visual Survey Form 10713995
Premise Address:
)
Block: 2.M Residential D Commercial J Name of Building:
Lot: Mix Use ❑ Other
# of Stories: AKA's:
Building Owner/Managgment: Telephone Number: ( )
Name: a~ ao~ (~ 1 FAX:
Address:
On Site Contact: A I'
Name: Telephone Number: ( )
Building Owner Management Activitie
Interior Survey Performed ❑ Yes ❑ 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 Kesuits:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to l" 0>1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0114t01" 0>1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ V to 1" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
Facade Description:
Roof
Debris: No Visible /Fine yer ❑'/~ to 1"i=i"" 0>1"
Description:
Setbacks N/Act'
Floor. Debris: ❑ No Visible/Fine Layer ❑ V2 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 ❑'/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0V to 1" ❑ > 1"
Comments
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Name: Agency:
NYC-WTC-000110160
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000110160Source: NYC Law Department, mirrored locally
DEP inspection form for 50 Broadway documenting building characteristics, facade conditions, and asbestos-containing material survey across multiple building faces.