NYC 9/11 Public Portal Document
VYTC Visual Survey Form
Premise Address:
Block: Residential 0 Commercial J Name of Building:
Lot: Mix Use M Other
# of Stories: 5 AKA's:
Building Ow er/Management: Telephone Number: (> )3/ ~_ (/am
c
Name: c I,C.'rô rQ .z-;. j,. ~- 7.i FAX:
Address:
On Site Contact:
Name: Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed Yes ❑ No
Exterior Survey Performed ~j Yes ❑ No
General Clean Up 2S'es ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring S'es ❑ No Locations:
Copies of All Reports and Data Requested Yes
V 1,Ud1 1IMPUI. IVII r%U*UILS.
Facade:
Inspected Debris
North ❑ N/A E'Yes No ❑ No Visible/Fine Layer ❑'/2to1" ❑>1"
South ❑ N/A BYes No ❑ No Visible/Fine Layer ❑'/atol" ❑>1"
East ❑ N/A ,~ Yes ❑ No ❑ No Visible/Fine Layer ❑'/% to 1 0>1'
West ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑'/2to 1 0>1"
Facade Description:
Roof
Debris: No Visible /Fine aver ❑'/ to 1" 1 {''' ❑ > 1" '1
Description:
Setbacks N/A ❑
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 ❑'/a to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date: (_//2002 Inspection Team: Name: Agency: \ _
Name: Agency: 4~
NYC-WTC 000114089
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