4 • WTC Visual Survey Form I OOO?i) In
Frernice Address:
1-L LJ
Block: a idential 0 Commercial J Name of Building:
Lot: IMixUse[3 Other
# of S orles: AKA's:
Building Owner!Managemerç Telephone Number: ( )
Name: . 'c ma=y 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 J Yes
Visual inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ h to l" 0>1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y to l" 0>1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1"
West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ V to 1" 0>1"
Facade Description: , ()
Roof
Debris: No Visible /Fine Layer [] % to 1" ❑ > 1"
Description:
Setbacks N/A
Floor. i Debris: ❑ No Visible/Fine Layer 9
V to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Vsible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ a to 1" ❑ > 1"
Department of Environmental Protection inspection form for WTC-area building documenting facade condition, asbestos, and other environmental hazard assessments.