WTC Visual Survey Fob
Premise Address: Sr (_ I QC
Block:
L'
Residential 0W Commercial Nam -of Building:
kJ
Lot: Mix Use ❑ Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: FAX:
Address:
On Site Contact:
Name: " ' A` 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 Yes ❑ No ❑ No Visible/Fine Layer h to 1" ❑ > 1"-
South ❑ N/A D Yes ❑ No ❑ No Visible/Fine Layer 'fl'/2 to 1" ❑ > 1"
East ❑ N/A 'fes❑ No ❑ No Visible/Fine Layer ' /2 to 1" E]> 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"
Facade Description:
0 1nI1♦w
Roof
Debris: ❑ No Visible /Fine Layer ❑ % to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer D% 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 ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
Comments
Date: Inspection Team: Name: I)°' ''' Agency:
Name: Agency:
NT ERE
NYC-WTC 000112487
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NYC-WTC_000112487Source: NYC Law Department, mirrored locally