WTC debris inspection form for residential building, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: \ Cp ,. e t- / 50 Block: Residential D Commercial D Name of Building. Lot: Mix Use Other # of Stories: AKA's: - Building Owner/Management: elephone Number: Name: FAX: Address: te On Si Contact: n Name: • %AA 0 , 1-~ ` Tele one ber: Building Owner Management Activities Interior Survey Performed Yes ❑ No Exterior Survey Performed es ❑ No General Clean Up es ❑ No Locations: ACM Clean Up Yes ❑ No Locations: Air Monitoring EYes ❑ No Locations: Copies of All Reports and Data Re uested Yes Visual Inspection Results: Facade: In ected Debris North ❑N/A Yes❑No ❑ No Visible/Fine Layer ❑%to 1" O>1" South ❑ N/A des ❑ No ❑ No Visible/Fine Layer ❑ % to 1" O>1" East ❑ N/A Ej Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" O>1" West ❑ N/A aYes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" O>1" Facade Description:

Roof

Debris: No Visible /Fine Layer ❑ % to 1" ❑ > 1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1' Floor: Debris: ❑ No Visible/Fine Layer ❑'h to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" Floor: Debris: ❑ No Visible/Fine Layer [] 4 to 1"

Comments

Date: \_,'L1 12002 Inspection Team: Name: L Agency: 'Q Name: Agency:

NYC-WTC-000112046