< WTC Visual Survey Form
r mise Address:
Block: (7j
_1 r( l S1
❑ Commercial ❑ Name of Building:
Lot: Mix Use ❑ Ot er ❑
# of Stories: AKA's:
Building Owner/Management: Telephone umber: (7/ f) L/J(/ _(L
Name: ASSA 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:
lnspecteçV Debris
North ❑ N/A ❑ Yes l l No ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer t~o 1" [1]> 1"
Façade ption:
cJ?\C __11 I \ I r ❑I'/22 (
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Roof
Debris: RNo Visible /Fine Layer to 1" ❑>1"
Description: 'v r• 1 c pr — ~(U
2Q1 P
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" M> 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Comments
Date: ~/~/2002 Inspection Team: Name: -)A3 hdn c _ Agency: i4S DO
Name: Q `'((j, Agency:
NYC-WTC- 000113350
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000113350Source: NYC Law Department, mirrored locally
DEP inspection form recording building details and facade conditions (north, south, east, west sides) with damage extent measurements and ACM documentation.
Department of Environmental Protection letter dated February 12, 2002, requesting building owners to submit environmental hazard assessments for 54 Warren Street.