WTC Visual Survey Form
Premise Address:
- 2 - -
Block: Residential 0 Commercial Name of Building:
Lot: MixUseD OtherlJ
# of Stories: AKA's:
Building Owner/Mana ement Telephone Number. ( )
Name: b o- Co 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 [] Yes ❑ No Locations:
Copies of All Reports and Data Requested fl Yes
Visual Inspection Results:
Facade:
Inspected Debris
North 0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer [] ~4 to 1' 9>1'
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ y4 to 1' 0>1'
East ❑ N/A ❑Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1' 0>1'
West ❑ N/A ❑ Yes D No ❑ too Visible/Fine Layer ❑ % to 1' 0>1'
Facade Description: n
Setbacks N/Ad
Floor____ Debris: ❑ No Visible/Fine Layer % to V ❑ > 1'
Floor. Debris: 0 No Visible/Fine Layer g % to V ❑ > 1'
Floor. Debris: 0 No Visible/Fine Layer ❑ '4 to V ❑ > 1'
Floor. Debris: ❑ No Visible/Fine Layer '4 to 1' 0> 1'
Floor. Debris: ❑ No Visible/Fine Layer H%tol, E],),. 1'
Comments
Date / c2Q Inspection Team: Name: Agency:
Name: Agency: _____
NYC-WTC 000112624
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000112624Source: NYC Law Department, mirrored locally