WIC Visual Survey Form
Preiaiise Address:
?2 wt, Sr Vr
Block: go I Residential ❑ Commercial I Name of Building:
Lot: Mix Use ❑ Other ❑ =(s'
# of Stories: 15 I AKA's:
Building Owner/Management: ( YTelephone Number: (2 la) 770 -3 1
Name: A c t i Ni t o REA Vz4{ FAX: (a I a) 4 O
Address: Ai.kE C ever !0 C E
On Site Contact:
'h
Name: ck Telephone Number: (212 ) •3
Building Owner Management Activi es
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up Yes ❑ No Locations: NO
ACM Clean Up ❑ Yes ❑ No Locations: •
Air Monitoring El Yes El No Locations:
Copies of II Rep and Data Reau d Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No [ 10 Visible/Fine Layer ❑ to 1"
1/ 2 ❑ > 1"
South ❑ N/A ❑ Yes ❑ No [SNo Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
F cade Desc iption:
'nc .fit • t_.dr► o i43
Roof
Debris: No Visible /Fine Layer ❑'/2 to 1" ❑ > 1"
Description: G r" !a 19wpAK 4OI .t . MU 141111 ItvA
3sei~r~r r wt i YW'f rQM + „YAL fWMrJ V ,trWT. r AAA \
Department of Environmental Protection letter dated February 12, 2002, requesting building owners to submit environmental hazard assessments for 54 Warren Street.