WTC Visual Survey Form ;fix, fp 0 t 0 '~' ~'
1' premise Address:
Block:
# I N btu W . S-r
Residential Commercial Name of Building:
Lot: Mix Use Other - —
# of S ones: 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 E]'/ to 1" D>1'
South ❑ N/A ❑ Yes Eli-No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/s to 1" ❑ > 1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑ % to 1" [1> 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" [1]> 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Comm
Standardized inspection form documenting building characteristics, asbestos materials assessment, and visual inspection results for facade debris on all four sides.
3 shared non-person entities · 1 shared topics · Same agency, volume and box · similarity 0.983