WTC Visual Survey Form
Premise Address:
v G✓i4R PA. S If ' /
Block: Residential j Commercial Name of Building:
Lot: Mix Use ❑ Other ❑
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: 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 ❑ Yes
Visual Inspection Kesuits:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine La er ❑'/% to 1" ❑ > 1"
South ❑ N/A Yes ❑ No No Visible me Lae ❑% to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine ayer ❑'/z to 1" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Ova to 1" ❑ > 1"
Facade Description:
Lns't( 4i
Roof
Debris: ❑ No Visible /Fine Layer ❑'/~ to 1" •1 =~''' ❑ > 1" "1
Description:
Setbacks N/AX
Floor: Debris: ❑ No Visible/Fine Layer ❑'/a to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ V2 to 1" ❑ > 1"
Comments
Date: I / .112002 Inspection Team: Name: f - f t 1 p tri -C (. Agency: (I
Name: • 11co oii et f/sT Agency: NYC I)6P
R -/7
NYC-WTC-000112656
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000112656Source: NYC Law Department, mirrored locally
Standardized inspection form documenting building characteristics, asbestos materials assessment, and visual inspection results for facade debris on all four sides.