NYC 9/11 Public Portal Document
ti I , WTC Visual Survey Form
PremiseAddress:
.- vJ A R e T,
Block: Residentiai Commercial ❑ Name of Building:
Lot: Mix Use Other El )or It Vo
# of Stories: 5 AKA's:
Building Owner/Ma gement: Telephone Number. ( )S CO
Name: (? tk oo e c --) /tA V11 FAX: )
Address: ccS 0 in O (L .
On Site Con pt:
)Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Perforp d ❑ Yes ❑ No
General Clean Up ['Y 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:
Inspected Debris
North ❑ N/A ❑ Y s ❑ No ❑ No isible/Fine Layer ❑'/2 to 1" ❑ > 1"
South ❑ N/A Ys ❑ No o Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
East ['N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ V2 to 1" ❑ > 1"
West 'N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Facade Description:
v s ~a o ` ~(\ e f1Or 0~ b
Roof
Debris: No Visible /Fine Layer ❑'/2 to 1" > 1"
Description: O Q G~ SS — G L cpy o a Ike f1
Setbacks N/A
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 El 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Com nt,~. ` '
—` i- V0.a~- ~~ ►CV-.~ 2 Fto Vinoccu iec
l L'r\o,-Yl ► nC Qv P C~ c
e ean r
k~ o -c C or e r '• m
,,,
e-01
Date: ~__/ /2002 Inspection Team: Name: ~{ G' -c r\ AZ ~~ Agency: 0
Name: Vnn c k0`~ Agency:
NYC-WTC-000113357
OCR can misread numbers and units. Confirm readings against the page image before using them.