WTC Visual Survey Form RIJ IDOI 020
Premise Addnass: ree+
Block: 13 Residential 0 Commercial D Name of Building:
Lot: Mix Use 1 Other ❑
# of Stories: AKA's:
Building Owner/Management Telephone Number: ( )
Name: FAX: ( )
Address:
On Site Contact:
Name: Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ 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 ebris
North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ 1/ 2 to 1" 0>1"
South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ 1/ 2 to 1" 0>1"
East ❑ N/A ❑ Yes ❑ No JJ Visible/Fine Layer
No ❑Y2 to 1" 0>1"
West []N/A ❑ Yes ❑ No LU No Visible/Fine Layer ❑%2 to 1" ❑> 1"
Facade Description:
Roof
Debris: ~No Vi4ble /fine Layer ( 2 to I" ❑ > 1"
Description: _ O bar c a u rta-s
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0 Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0 '/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
Comments
Date: 2/ r'2L12002 Inspection by: Name: AP Agency: DEP
Name: Agency:
NYC-WTC 000112312
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000112312Source: NYC Law Department, mirrored locally
WTC debris inspection form documenting visual inspection results for facade condition, ACM assessment, and building characteristics for a 3-story structure.
Joint memorandum from NYC DEP and DOH advising building owners on post-9/11 maintenance, re-occupancy issues, and hazardous material assessments including asbestos.