Block: ResidentialD Commercial j Name of Building:
Lot: Mix Use ❑ Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: MC 4 L 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 Kesuits:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ h to 1" 0>1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑/to1" 0>1"
West ❑ N/A [] Yes ❑ No ❑ No VSible/Fine Layer E]%to 1" 0>1"
Facade Description: ,1 fl -
Roof
Debris: o Visible/Fine Layer ❑ h to 1" ❑ > 1"
Description:
Setbacks N/A►'
Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
L
Date: I2pp Inspection Team: Name: ' Agency:
ENT Name: Agency:
NYC-WTC-000113620
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000113620Source: NYC Law Department, mirrored locally
Department of Environmental Protection inspection form for WTC-area building documenting facade condition, asbestos, and other environmental hazard assessments.