Block: I -33 Fesidential ❑ Commercial El Name of Building:
Lot: T7 5t'3 Mix Use ❑ 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 Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1"
West , ❑N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑'/2 to 1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑'/2 to 1" ❑ > 1"
Description:
Setbacks N/A.❑
Floor: Debris: ❑ No Visible/Fine Layer El 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"
Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Comments' 1 )
I
Date: / / /2002 Inspection Team: Name: (I Ot' Agency:
Name: V- —A NU
Jr
NYC-WTC-000113353
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NYC-WTC_000113353Source: NYC Law Department, mirrored locally