NYC 9/11 Public Portal Document
._.__._..._. ... ~ ~.~~_~.... . ~.~e>.a. ...._r _
IOO ~ cc KJ
WTC Visual Survey Form
Premiss' d ess:
Block: Residential ❑ Commercial Name of Building:
Lot: Mix Use ❑ Other ❑ 'DtMTsGIc /►N11.
# of Stories. AKA's: ? $G NK N t "V t,
Building Owner/Manag ent: Telephone Number: (zl2) (,y$-
Name: A &, .- 1SId FAX: (Z Z ) ç io
Address:
On Site C
Name: Telephone Number: ( )
Building Owner Managem t Activities
Interior Survey Performed XYes ❑ No
Exterior Survey Performed ❑ Yes ❑ No ls% f
General Clean Up EYes ❑ No Locations: '&Ot im kbt419(41 ,ui
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 GA ,
North ❑ N/A es ❑ No ❑ No Visible/Fine Layer ❑% to 1" ❑ > 1"
South ❑ N/A es ❑ No ❑ No Visible/Fine Layer Li 1/2 to 1" ❑ > 1"
East ❑ N/A es❑No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
West ❑ N/A t yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Roof
Debris: ❑ No V' ibl /Fine !j % to 1" R> 1"
Description:
Setbacks N/A fl See" 40O f'O.0
Floor: O Cl uebris: ~]L No Visible/Fine Layer ❑'h to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ~'/2 to 1" ❑ > 1" Z 31 DIE S
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 ❑Y2 to 1" ❑ > 1"
Date: ... .2J...JqJ2OO2 Inspection by: Name: 1LaAy MA jency: PCDEP
Name: gency:
NYC-WTC-000112558
OCR can misread numbers and units. Confirm readings against the page image before using them.