WTC Visual Survey Form LO19OS1 (3
Premise Address:
' /z fLA 7t $7-
Block: - Residential El Commercial j J Name of Biilding:
Lot: 013 Mix Use ❑ Other ❑ La ~~ ✓ ~:..u~
# 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 Yes
Visual Inspection KeSults:
Facade:
Inspected Debris
North ❑ N/A ® Yes ❑ No t isib1efFine Layer ( '/2 to 1" ❑ > 1"
South 0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El Y2 to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West E0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1"
Facade Description:
Roof
Debris: ❑ No Visible fFine Layer Eg / to 1" J> 1"
Description: !2-# lQ pLtt
.
Setbacks N/A jl
Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to,1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Joint memorandum from NYC DEP and DOH advising building owners on post-9/11 maintenance, re-occupancy issues, and hazardous material assessments including asbestos.