NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address ,
()
Block: I Residential j Commercial ❑ I Name of Building:
Lot: I Mix Use Other ❑
# of Stories: AKA's:
Building Owner/Management: Telephor
Name: N, i,t7 ► FAX:(
Address: 1 ~o ~•\ Z'=
On Site Contact:
Name: 'A Telephon
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Perform ❑ Yes ❑ No
General Clean Up Tes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All F
Visual Inspection Results:
Facade:
lnpØcted De)ris
North ❑ N/A es ❑ No No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
South ❑ N/A I i1Xes ❑ No ❑ No Visible/Fine Layer El /2 to 1" ❑ > 1"
East ❑ N/A J es ❑ No c'qc~~,,~~ Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
West ❑ N/A ❑Yes ❑ No '}ac.' No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Facade Description:
i~kk)A-tF ~1,i n D~ 1-1 AS r- C c A -IFS etc J-rL_`
Roof
Debris: 'No Visible /Fine Layer ❑ '/2 to 1" ❑ > 1"
Description: -~,a.s Cn l~tf1 \ Ask A e_ Q \ VA-r
Setbacks N/A'
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1"
C ments
T Du 91 5 Z r; L 7 a-E ,cc) - pt S C L.C-1h~1 's
~\ I -r e (L- Z i',c? I OGL
Date: /L-5 /2002 Inspection Team: Name: c1 G~
_______Agency:N.) DOL
Name: I+P l _ Agency,
NYC-WTC-000113278
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