Block: ' Residential II Commercial LI
~ Name of Building:
Lot: 2. \ Mix Use ❑ Other ❑
# of Stories: 5 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 Results:
Facade:
InspEcted Debris
North ❑ N/A ' Yes ❑ No ❑ No Visible/Fine Layer ❑ 1
/2 to 1" ❑ > 1"
South A []Yes ❑ No ❑ No Visible/Fine Layer ❑ to 1"
1/ 2 [1> 1"
East NJA [I Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1"
West • rN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
1
Facade Description:
2
Roof
Debris: ❑ No Visible /Fine Layer ❑ Y2 to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"