Block: Residential p Commercial Name of Building:
Lot: Mix Use 0 Other
9 of Stories: AKA's:
Building OwnerlMana ement Telephone Number. ( )
Name: `b —7 .2Z a...~ FAX:
Address:
On Site Contact
Name: " Telephone Number.
Building Owner Management 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 L] 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 D % to 1 ' 9>1 '
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ i4 to 1' 0>1'
East ❑ NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ h to 1' 0>1'
West ❑ N/A ❑ Yes D No ❑ No Visible/Fine Layer ❑ 34 to 1' ❑ > 1'
Facade Description: n n