WTC Visual Survey Form
Premise Address:
2
.Block: I I Residential fl Commerci Name of Building:,
Lot: I Mix Use ❑ Other ❑
# of Stories: J AKA's: - 6 -& 'o r / - ,Q eryi
Building Ow er/Managgme t: Telephone Number: (7-')C
Name: ~1 ,~ ~p .- '^ ( )
Address: W v 1A ~A 2~z
On'Site tam:
Telephone Number: ( )
Building Owner ManagemefltActivities
Interior Survey Performed DYes ❑ No
Exterior Survey Perfotmed EYes ❑ No
• General Clean U s ❑ No Locations: I
ACM Clean Up Yes No Locations:
Air Monitoring J' es ❑ No Locations:
Copies of All Reports and Data Requeste` Yes
•
3Visual Inspection Results: / \
Facade:
Inspected Debris
North N/A Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
South [N/A ' Yes El No No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
East ❑ N/A [Yes ❑ No No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
West ❑ N/A Yes ❑ No No Visible/Fine Layer ❑'h to 1" ❑ > 1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer f j -to1" 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: ___ Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1"
Comments
•,.Date: / Inspection Team: Name: L"'- LL' C tM(-01 Agency:
Name: Agency:
NYC-WTC 000113974
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NYC-WTC_000113974Source: 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.