WTC Visual Survey Form 1/) XS 36 I
Premise Address: (
w
Block: Residential Commercial Name of uildi g: wiJirru2..tL
Lot: r Mix Use Other
# of Stories: AKA's:
Buiidin n na men • Telephone Number. ( )
Name: ,g •F
Addres .
On Site ontact:
Name: ' ' Tele hone P4mber
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
y
General Clean Up ❑ Yes 0 No Locations:________________________________________
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested D Yes
Visual inspection Results:
Facade:
Ins .pected ris
North ❑ N/A [a'Y s ❑ No ,r ,~ Visible/Fine Layer ❑htol" ❑>1"
South ❑ N/A [4s ❑ No ~o Visible/Fine Layer ❑%to1" ❑>1"
East ❑N/A [~" es❑No [ lo Visible/Fine Layer ❑htol" ❑>1"
West 9 -N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Ytol" ❑>1"
Facade Description: