Block: Residential Commercial 0 Name of Building:
Lot: Mix Use Other ❑
# of Stories: t AKA's:
Building Owne IMana eme t: Telephone Number: (3 ) a 33 -
Name: 0 FAX: I ~) 02~ 3 —
Address: -'?i C3Q k) fOO7
On Site Contact:
Name: S Telephone Number. (2/o?') 0933- (;1T
Building Ovine Manageme t Activities
Interior Survey Performed EYes ❑ No
Exterior Survey Perfo d El Yes ❑ No
General Clean Up [Vies ❑ No Locations: t N- f 19 t
ACM Clean Up
Air Monitoring
❑ Yes ❑ No Locations:
❑ Yes ❑ No Locations:
J V
oi'
A \1
rC() (
((i
YOM-7(
€71ft
Copies of All Reports and Data Requested ❑ Yes
'I
x.~ - Yt-)I Ic:ter 1 i0 tO r-vic c.
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A es ❑ No [4lo Visible/Fine Layer ❑'/ to 1" ❑ > 1"
South ❑ N/A JYes ❑ No [ 1o Visible/Fine Layer ❑ % to 1" ❑ > 1"
East ❑ N/A jXes ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
West • ❑ N/A Yes ❑ No [ 'No Visible/Fine Layer ❑ /z to 1" ❑ > 1"
Facade Description:
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 275 Greenwich Street dated February 12, 2002.