WTC Visual Survey Form
Premise Addres
1 1jJ LL -- .E
Bloc I ResidentialD Commercial I Name of Building:
Lot: I Mix Use El Other ❑
# of S ories: AKA's:
Building Owner/Management: IN -A
Telephone Number:
SL?
i(
Name: r Q FAX: r ~~
Address: j OO5
On Site Co
Name: 0 0Q.1 Tele hon N ber: ~~-/
Building Owner Management Activities CA 5~ PO D
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up []Yes ❑ No Locations: .f b 'n
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 es ❑ No No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
South
East
West
❑ N/A
❑ N/A
❑ N/A
Facade Description:
es ❑ No
es ❑ No
fesE)No r o Visible/Fine Layer ❑'/z to 1"
No Visible/Fine Layer ❑ Y2 to 1"
o Visible/Fine Layer ❑ Y2 to 1"
[1> 1"
❑ > 1"
❑ > 1"
Roof
Debris: No /Fine Layer ' )'/ to 1" > 1"
Description: n ~-( r Q wv c~ v\X) ,. <n~
n
Setbacks N/A
Floor: Debris: No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ' 2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer /2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Date: C /_~ /2002 Inspection bv• Name• 1 r1c l D t tJ( aency: /)//, Dpk
Name: Agency:
I NYC-WTC- 000112237
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000112237Source: NYC Law Department, mirrored locally
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 275 Greenwich Street dated February 12, 2002.