Block: Residential 0 CommercialD Name of Building:
Lot: Mix UseD Other
# of Stories: 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 p Yes
Visual Inspection Results:
Facade:
Inspected is
North 94I Yes o
oVisible/Fine Layer D%to1' ❑> 1'
South es ❑ No pNroVisible/Fine Layer ❑ % to 1' ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ h to l' [3> 1'
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y to 1" F]:,- 1"
Facade Description: