WTC Visual Survey Form
remise Addre
2 -L Z i A i e~ (
Block: Residential Commercial D Name of Building:
Lot: Mix Use ® Other
# of Stories: S 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/F' a er ❑Y2to1" 0>1"
South ❑ N/A ® Yes ❑ No No Visible ine Laye ❑ ~~2 to 1 " 0 >1"
East ❑N/A ❑Yes❑No O No Visible/Fine aver E]v2 to 1" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑•> 1"
Facade Description: •
LrI , L- th
Roof
Debris: ❑ No Visible lFineI.ayer ❑ % to 1" •1 ~"' ❑ > 1" 1
Description:
I'-'I ?9ccesf.
Setbacks N/A Q
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'a to 1" 0> I"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Comments
Date: t i /2002 Inspection Team: Name: • yh 17 ' c. K Agency: d f EP,p
Name: v►c i/ Agency: Nti C
NYC-WTC-000112740
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000112740Source: NYC Law Department, mirrored locally
DEP inspection form recording building details and facade conditions (north, south, east, west sides) with damage extent measurements and ACM documentation.