WTC Visual Survey Form
Premise Address: - ` I.
t1—
Block: Residential 0 CommerciØ Name of Building:
Lot: Mix Use Other
# of Stories: AKA's:
Building Own /Management: Telephone Number: (, )
Name: FAX:
Address:
On Site Contact:
Name: Telephone Number:
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed 0 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 ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'% to 1" ❑ > 1'
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ h to 1' ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
West ❑ N/A s ❑ No ❑ No Visible/Fine Layer/a to 1" ❑ > 1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑ Va to 1' ` ❑ > 1'
Setbacks N/A ❑
Floor Debris: 0 No Visible/Fine Layer ❑ % to 1 ❑ > 1'
Floor. Debris: ❑ No Visible/Fine Layer 0 Va to 1' ❑ > 1'
Floor. Debris: ❑ No Visible/Fine Layer ❑ s to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑'/a to 1' ❑ > 1'
Floor Debris: ❑ No Visible/Fine Layer ❑ i4 to 1' ❑> V
Comments
DEP inspection form for 50 Broadway documenting building characteristics, facade conditions, and asbestos-containing material survey across multiple building faces.