WTC Visual Survey Form
Premise Address: "
-r
Block: I Residential ❑ Commercial ❑ I Name of Building:
Lot:
# of Stories: AKA's: 1 c. t r ~n
Building Owner/ nag nt: ep one Number: Z
Address:
On Site Contact:
Name: j ç TuAq Telephone Number. (p?ia
Building Own r Manage ent tivities
Interior Survey Performed es ❑ No r'.
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up F] 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 rs
North 0 N/A [ es ❑ No M o Visible/Fine Layer ❑%to1" ❑>1"
South ❑ N/A [ es ❑ No R'No Visible/Fine Layer ❑'h to 1" E1> 1"
East
West
❑ N/A
❑ N/A
Facade Description:
[2 es ❑ No
[ es ❑ No Rt o
Visible/Fine Layer
Visible/Fine Layer
❑%tol"
❑Y2to1"
0>1"
0>1"
Roof
Debris: No Visible /Fine Layer ❑'/2 to 1" ❑ > 1"
Description:
Setbacks N/A
Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" [1> 1"
Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" [1> 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" M> 1"
Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Comments
—Tt~h - (r(onr 2',
Date: (//2002 Inspection Team: Name: E(ORTDr1 })tr4.DR I C N Agency: S W(-
Name: Jlj (~ CO CLL'.( Agency:
NYC-WTC-000113001
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000113001Source: NYC Law Department, mirrored locally
Department of Environmental Protection WTC building inspection form for 30-story structure documenting facade inspection results, ACM sampling status, and building contact…
Department of Environmental Protection WTC building inspection form for 30-story structure documenting facade inspection results, ACM sampling status, and building contact…