WTC asbestos inspection form, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form t00 t Z $ I Premise Address: 1' (O L. LIAPA ST. Block: Lot: 9p 3 I Residential tMbcUseDOtherrl Commercial jJ I Name of Building:

# of Stories: I AKA's: I I5 Building Owner/Management: Telephone Number ( ) Name: FAX• Address: .. On Site Contact: Name: Telephone Number X Z. Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up 0 Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring 0 Yes ❑ No Locations: Copies of All Reports and Data Requested Yes Visual Insi*ctlon Results: Facade: Inspected Debris North ❑ N/A ❑Yes ❑ No 0 No Visible/Fine Layer ❑%to 1" 0>10 South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>10 East ❑ N/A ❑Yes ❑ No ❑ No Visible/Fine Layer ❑Yto1" ❑>1" West ❑N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑%to1" 0>1" Facade Description:

Roof Debris: to 1" 0>1" Description:

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer ❑ 34 to 1" 0>10 Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ i4 to 1" 0>1" Floor„_ Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Floor Debris: ❑ No Visible/Fine Layer ❑ Ya to 1" 0>10

Comments

H

Date: / /2002 Inspection by: Name: Name: L.L.. Agency: Agency: LL V, NYC-WTC- 000110792