WTC Visual Survey Form
aiz.ani:%e Address:
fo4 ~~ Rde -e4
Block: Residential 0 Commercial D Name of Building:
Lot: Mix Use J Other
# 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 Yes
vIsuaI inspeauun mutoww:
Facade:
Inspected Debris
North ❑ N/A ® Yes ❑ No No Visible per ❑ % to 1"' 0>1"
South 0 N/A ® Yes ❑ No bd No Visible/ er ❑'/ to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Facade Description:
Roof
Debris: No Visible / r ❑ % to 1" 0>1"
Description:
Setbacks N/A,
3 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: 0 No Visible/Fine Layer ❑ i4 to 1" ❑ > 1"
Comments
Date: t l a ) 12002 Inspection Team: Name: K A-ni Agency: De p
Name: Agency:
NTERE-&
NYC-WTC-000114579
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NYC-WTC_000114579Source: NYC Law Department, mirrored locally
Form recording visual inspection results of facades and air monitoring data for the building at 110 Reade Street following the World Trade Center attacks.