WTC Visual Survey Form
Premise Address:
2 e c.4-° ,,
Block: Residential Q Commercia Name of Building:
Lot: Mix Use ❑ Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: FAX:
Address:
On Site Contact:
Name: ~ G~ ~ `' . Telephone Number: ( )
Building Owner MB1iagement 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 Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'%to l" ❑> 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/a to 1" 0>1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El'% to l" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%tol" ❑>1"
Facade Description:
Roof
Debris: o Visibl Layer ❑ % to 1" ❑ > 1"
Description:
J
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ Ya to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑> 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date: V / l 0 /2002 Inspection Team: Name: L '`r " Agency:
;E N T E R Name: Agency:
E3
NYC-WTC 000113973
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000113973Source: NYC Law Department, mirrored locally
A letter from the Department of Environmental Protection requesting copies of environmental hazard assessments and cleanup summaries for buildings near the World Trade Center site.