NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
Block: I
r)
Residential ❑
A S-i-
Commercial ❑ Name of Building:
Lot: I Mix Use ❑ Other ❑
# of Stories: AKA's:
Building O ner/Manage, ent: Telephone Number: )-7 3• - LC
Name: Ob \- c`C FAX: ( )
Address:
On Site-Sontact:
Name: Telephone Number: ( Q) - _O b
Building Owner Manage nt Activities ~,~ ~,,~,,.dy (. &Q
Interior Survey Performed ❑ Yes ['Jo .~ ~~,~{
Exterior Survey Performed ❑Yes [~ No
General Clean Up FYes ❑ No Locations: -
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes [ No Locations:
Copies of All Reports and Data Requested ❑ Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A Yes ❑ No Vifr o Visible/Fine Layer ❑ to 1"
Y2
South ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ to 1"
Y2
East ❑ N/A KZ es ❑ No f 4o Visible/Fine Layer ❑'/z to 1"
West ❑ N/A [Y es ❑ No ['No Visible/Fine Layer ❑ Y2 to 1"
Facade Descriptiori (1
N!
~-. - - -
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
Date: / /2002/ Inspection Team: Name: \\ . Agency:
Name: y Agency:
NYC-WTC-000112815
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