NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
t esiaentiai u Name of Bu na-
Lot: Mix Use 0 Other
# of S1 AKA's: cgtilN,oz (,oc1c7c,
Buiidil er/Management Telei
Name: - ow.~ C eIapr+-,eO Q - P• FAX:
ciol
On Site Contact:
Name: " TeleDt
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:
Cosies of All
Visual Inspection Results:
Facade:
In acted De 1s
North yes ❑ No [vj Visible/Fine Layer ❑ % to 1' ❑ > 1'
South Et L Yes ❑ No [ 'No Visible/Fine Layer ❑ % to 1' ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Ova to 1' ❑ > 1"
West ❑ N/A L] Yes 0 No ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Facade Description:
Roof
Debris: Do Visible /Fine Layer .❑ 3 to 1" ❑ > 1"
Description:
Setbacks N/A0
Floor. Debris:D No Visible/Fine Layer ❑ % to 1" ❑ > 1'
Floor. Debris: ❑ No Visible/Fine Layer ❑% to 1' 0> 1'
Floor. Debris: ❑ No Visible/Fine Layer ❑ 3% to 1" ❑ > 1'
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to V 0>1"
Comments
Date: 17t 12002 Inspection Team: Name: t th Agency:
N TE Name: Agency:
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. •_ T., _~ _ , ._ T _ _._ _ . _
NYC-WTC 000113779 ~ - ^- -~ -- -- " •
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