WTC building inspection form with visual assessment results

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: — —

Block: Residential D Commercial D Name of Building: Lot: I Mix Use El Other # of Stories: 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 Kesuits: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" 0>1" South ❑ N/A © Yes ❑ No ❑ No Visible/Fine Layer Q'/2 to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ 2 to1" 0>1" Faca a r1%escript•ion. -~ L 'ti v e4 ( A Hr C -1.,-

Roof 1

Debris: ❑ No Visible /Fine tayer Description: f ti` sI1t r i^) I -f

Setbacks N/A Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: ("I / 27 /2002 Inspection Team: Name: Agency: Name: I r i- v ', L ►; Agency:

NYC-WTC-000113132