NYC 9/11 Public Portal Document
$ WTC Visual Survey Form
Premise Address:
j O AJc cQ ,(1 .
Block: Residential ❑ Commercial ❑ Name of Building:
Lot: Mix Use Other❑
# of Stories: AKA's: c -s
Building Owner/Management: Telephone Number: (L-1 )5z-'/ -c
Name: N uiS i ii6 crjLP FAX: ( )
Address: ^n Z''=`
On Site Contact
Name: 5-fV'A Telephone Number: ( 5 _ 2q
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No ~~ 2 n~ p
~~r ' KTC
Exterior Survey ❑ Yes ❑ No
General Clean UpPerf~~R
E1es 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 [ es ❑ No [ No Visible/Fine Layer ❑ 1/z to 1" ❑ > 1"
South ❑ N/A D,Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/2 to 1" [1> 1"
❑ N/A es ❑ No ~'/,\*77%k Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
East
West ❑ N/A
Facae. Description:
Ey
es ❑ No 14c-1'A No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
i~kk)A7~ ~i n AcP c 1-\ Ac t3C1;N Ci c Ai-t f2-CCEk'-rL>I
Roof
Debris: No Visible /Fine Layer ❑'/to1" ❑>1"
l A ~.-
Description:
Setbacks N/Ag"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
CQniments
,Di . v-i c OG i,~l ,A C l.C-f&9 j C 1OGZ-
Date: ! /2002 Inspection Team: Name: "1t; U(1 Can G Agency: DQ
Name: c Agency-K C
NYC-WTC 000113279
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