Block: Residential ❑ Commercial Name of Building:
Lot: Mix Use ❑ Other ❑ 1DC µ 4r9Cd~ NN1~•
# of Stories. AKA's: ? G A HK 6 '
Building Owner/Manag ent: Telephone Number: (Z1Z y $
Name: C.(~ 1h11i*i► w,k id FAX: (Z S) 68 çio
Address:
On Site C n ct:
Name: Telephone Number: ( )
Building Owner Managem t Activities
Interior Survey Performed iYes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up &Yes ❑ No Locations: "$,V0*A0t00M0%kb
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring BYes ❑ 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 ❑/2 to 1" ❑>1"
South ❑ N/A Yes ❑No ❑ No Visible/Fine Layer 0'/2 to 1" 0>1"
East ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑> 1"
West ❑ N/A es ❑ No ❑ No Visible/Fine Layer 0'/2 to 1" ❑>1"
Roof
Debris: ❑ No V' ibl /Fine K]'h to l" 0>1"
Description:
Setbacks N/AJJ pK 4.o. f'OC
Floor: 01 C1 ebris:IN No Visible/Fine Layer ❑ % to 1" ❑ > 1" -
Floor: Debris: ❑ No Visible/Fine Layer H Y to 1" ❑ > 1"2 31 Or S
Floor: Debris: ❑ No Visible/Fine Layer %2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer El Va to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Date: /N/2002 Inspection by: Name: cy:
Name: cy:
NYC-WTC-000112562
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NYC-WTC_000112562Source: NYC Law Department, mirrored locally