WTC Visual Survey Foj m
Premise Address: ~
L+ j4 U Q CG
Block: Residential 0 Commercial Nam -of Building:
Lot: Mix Use JJ Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: FAX:
Address:
On Site Contact:
Name: Telephone Number:
Building Owner Managenient 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 Debris
North ❑ N/A es ❑ No ❑ No Visible/Fine Layer /2 to 1" ❑ > 1" .
South ❑ N/A ] Yes ❑ No ❑ No Visible/Fine Layer TJ Y2 to 1" ❑ > 1"
East ❑ N/A des❑ No ❑ No Visible/Fine Layer c '/2 to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Facade Description: AA
() .l . w It dr
Roof
Debris: ❑ No Visible /Fine Layer ❑ Y2 to 1" ` ❑ > 1" -
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"
Comments
Date: 6 / l 7 /2002 Inspection Team: Name: Agency:
Y
Name: Agency:
N T ERE`
NYC-WTC 000112495
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NYC-WTC_000112495Source: NYC Law Department, mirrored locally