NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
tial Commercial K, ~ Name of Building:
Lot: 4
Block:.,- ca~~ 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 fl Yes
visual inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ V2 to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1"
Facade Description:
w,:<tcv u. Nc - ti<c Air, JI
Roof st
Debris: ❑ No Visible /Fine tayer ❑'A to 1" •1 -4'" t j_] > 1" 1
Description:
Setbacks N/A❑
Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1' ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'4 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1' ❑ > 1'
Floor: Debris: ❑ No Visible/Fine Layer ❑'Ato 1" ❑ > 1"
Comments _
G f L~ StV-~ /A[ l l -c tZ Y ,w
CD+. . (' , ~.+.~ r-~ , t!i x - .~ ~ M . i. , f . 1 i~rYY.
Date: CL/?1_/2002 Inspection Team: Name: Ac Agency:
Name: Hi-i2 e c r. Agency:
NYC-WTC-000113412
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