WTC Visual Survey Form
Premise Address:
r " ST I
Block: 4db Residential ❑ Commercial I Name of Building:
Lot: I Mix Use ❑ Other ❑
# of Stories: AKA's:
Building Owner anagement: Telephone Number: ( )
Name: A 5 ILLtAh :( )
Address:
On Site Contact:
Name: `~4 a €tal O,rf Telephone Number: 1'L
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No eht 4E&rl•ip
Exterior Survey Performed ❑ Yes ❑ No
~k 'W 6. %r fT
General Clean Up ❑ Yes ❑ No Locations: S
ACM Clean Up ❑ Yes ❑ No Locations: V
Air Monitoring ❑ Yes ❑ No Locations:
ro i drW Copies of All Reports and Data Requested ❑ Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
South ❑ N/A []Yes ❑ No []No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Facade Description:
Roof
Debris: ❑ No Visi le /Fine ayer % to 1" • ❑ > 1_'
Description:
Setb N/A ❑
O
vis wlt ó4rfs
loor: Debris: ❑ No Visible/Fine Layer ®'/z to 1"/ ❑ > 1"
$11b4
loor: Debris: ❑ No Visible/Fine Layer [T~e '/2 to 1" ❑ > 1" ~~
• Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" .~
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"~,,~
Comments
Date: _._2__i ,I /2002 Inspection by: Name: %gency: 1V G E
Name: Agency:
NYC-WTC 000112594
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NYC-WTC_000112594Source: NYC Law Department, mirrored locally