WTC Visual Survey Form
Premise Address:
Wcccr S•
Block: esidential LJ Comme cial me of Building:
Lot: Mix Use ❑ Other
# of Stories: AKA's:
Building ner/ nagement: _ Telephon Number: ) 3-
Name: \-- . b c ;,FAX: 9 ) 0
Address:
On Site Contac : -
Name: Telephone Number. ) 33 ''W-+
Building Owner Mnagement ctivities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up es ❑ 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 /A El Yes ❑ No ❑ No Visible/Fine Layer ❑% to 1" [2 > 1"
South /A ❑ Yes ❑ No ❑ No Visible/Fine Layer [J% to 1" [2 >1"
East /A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1"
West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer E]'/2 to 1" [2 >1"
Facade Description:
Roof
❑ NoNi [2 >1"
Debris:
Description: M /Fine Layer 12 1/ 2 to 1"
Setbacks N/A
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" [2 >1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" [2 >1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" [2 >1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" [2 >1"
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 141 Greenwich Street dated February 12, 2002.