NYC 9/11 Public Portal Document
WTC V9s!1?J Survey Form
Premise Address:
BIock:L& ResidentialLj CommercialD Name of Building:
Lot: of Mix UstJ Other I ivc1r
# cif Stories: AKA's:
Building Owner/Management: Telephone Number: (
Name: 1..b - r; . '~'4J~- iV FAX: ( )
Address:
On Site Contact: ,0,,
Name: ' ' ~5 -~c 1 Telephone Number: (212) 34-9 ,
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 Results:
Facade:
Inspected Debris
North N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/2 to 1" 0>1"
South ❑ N/A Yes ❑ No ,.® No Visible/Fine-beyer ❑'/to1" 0>1"
East N/A DYes ❑ No ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
West 'N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
Facade Des iption:
t Jj raw LU ' G L 11?-/L(
Roof
Debris: ❑ No Visible /Fine Layer ZJ'/to1" 0>1"
Description: Fv L.t tI-1.) Li P
Setbacks N/A,j~
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"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Comments
Date: / /2002 Inspection Team: Name: Agency: h~
'► A/ 7. Name: Agency:
NYC-'WTC-000114533
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