WTC Visual Survey Form
Premise Address:
Zoe e S 4e~'
Block: Residential 0 Commercial D Name of Building:
Lot: Mix Use J Other 0 j -i i ct- c=v-~c rF
# of Stories: 7 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 DYes
V Isudl inspe~uUn RCsuuw.
Facade:
Inspected Debris
North ❑ N/A Yes ❑ No JZ No Vsible/F ❑ % to 1"
South ❑N/A Yes❑No No Visible ❑ % to 1"
East ❑ N/A DYesDNo O No Visible/Fine Layer ❑'/ to 1"
West ❑ N/A ❑ Yes ❑ No ❑ No VSible/Fine Layer ❑ % to I"
Facade Description:
Roof
Debris: No Visible /Fine Layer ❑ %% to 1" ❑ > 1"
Description:
Setbacks N/A J
Floor. Debris: ❑ No Visible/Fine Layer ❑ Y: to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0 Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 6 to 1" ❑ > 1"
Comments
Date: c/ 01 /2002 Inspection Team: Name: le. Am Agency: .DP —
Name: Agency:
NT E R
NYC-WTC 000114545
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NYC-WTC_000114545Source: NYC Law Department, mirrored locally