NYC 9/11 Public Portal Document
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WTC Visual Survey Form
Premise Address: 1I 11
'O WC CC\ s-.
Block: Residential J Commercial Name of Building:
Lot: Mix Use jA Other ❑
# of Stories: AKA's:
Building Owner/Management Telephone Number. ( I )5_9 -~
Name: FAX:( )
Address:
On Site Contact
Telephone Number: ( rJ 29
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No 2 E, E ct t _ 0 6L
Exterior Survey Perfornjd ❑ 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:
Ins cted De is
North ❑ N/A s ❑ No [ No Visible/Fine Layer El /2 to 1" ❑ > 1"
South ❑ N/A [,Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1" []>1"
East ❑ N/A es ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
West ❑ N/A E Yes ❑ No P4c-1' No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Facae Description:
-r ter
,i,En( -kAS 3t<1;N Ci c A -I CEIJ-rL-1
Roof
Debris: & No Visible /Fine Layer ❑'/2 to 1" ❑ > 1"
Description: P\ P " - AZ t
- Joo- ce)c 11\~c - - Pc l S (-\cs 0-TS
ter, -1 (t Cp i
Setbacks N/A "
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Comments
DLtP1 S-- -re J7 2E ç c-c)r i1AS Cl l& I I -rE (L- F„c7 1OL-
~1 19-,.1 u)1 i 1:13 215 L P-O M (1I I 1 I O a '
Date: ~/L 5 /2002 Inspection Team: Name: C~` Cr1 KeykcinCt Agency: ) & DO
Name: knr L¼ t , Agency,
NYC-WTC-000113275
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