NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
—' C u 1 E
Block: I Residential ❑ CommercialD I Name of Building:
Lot: Mix Use ❑ Other ❑
# of Stories: .>I AKA's: 1- 3 —/ -
Building Owner/Management: Telephone Number: (7_/ ) Gf'6 L(- -3
Name:
Address: 1- c
On Site Contact:
Name:
Building O,ner Management ctivitie p
Telephone Number: Qt )5 3 c
N j C
Interior Survey Performed >' es E] No
Exterior Survey Performed Yes ❑ No
General Clean Up [ es ❑ No Locations: o - /1)
ACM Clean Up Yes ❑ No Locations:
Air Monitoring Yes fl No Location
\ of All Reports and Data Request Yes
visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A [ es ❑ No ❑ No Visible/Fine Layer ❑ 1
/2 to 1" ❑ > 1"
South ❑ N/A ['Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
East ❑ N/A E2'Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
West , ❑N/A [}4es❑No ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
Facade Description: n
Q- n rc Ufd n s,, ~D A •. A J Iin .
Roof
Debris: ❑ No Visi le /F• a Lyeç ,LI % t 1" ❑ 1"
Description: - \"t) -,
V Ac.
Setbacks N/A ❑
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"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Comments , 1, 11 A 11 11 . : (1' /. t Ir _ ~.
f
HI
Date: t_/ /2002 Inspection Team: Name: GI e —ro ►-1 C [ Agency:
~,n
f Name: rgency: Q
NYC-WTC-000113398
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