Block: (' Residential Commercia1 Name of lding:
Lot: 3 Mix Use ❑ Other ❑ --gov.«e ~C
# of Stories: AKA's:
Building Owner/Manag ent: Telephone Number: (~, ) j f
Name: .Qi -v FAX:( ) 7-' /
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 Ins on Results:
Facade:
Ins ected Dett~rris
No N/A Yes ❑ No o Visible/Fine Layer E]Y2 to 1" 0>1"1-
S th N/A s❑No ❑ No Visible/Fine Layer El'/2 to 1" 0>1"
East ❑-N/A s❑No .1 No Visible/Fine Layer ❑'/2 to 1" 0>1"
West ❑ N/A F s❑No ~No Visible/Fine Layer ❑Y2to l" 0>1"
Facade Description:
Roof
Debris:
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer El 1/2 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 El 1/2 to 1" ❑ > 1"
Comments
Date: / - /2002 Inspection Team: Name: Agency:
Name: Agency:
ENTE RED
NYC-WTC- 000113762
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NYC-WTC_000113762Source: NYC Law Department, mirrored locally