WTC Visual Survey Form
Prer ise Address:
log
Block: Residential 9 Commercial 9 Name of Building:
Lot: Mix UseD 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 fl Yes
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Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
South ❑ N/A ® Yes ❑ No B No Visible/Fin*6aye - ❑ va to 1" 0>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 /Fier 9
V to 1" 9> 1"
Description:
Setbacks ° N/A,
Floor: Debris: ❑ No Visible/Fine Layer 0
V to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1'
Floor: Debris: 0 No Visible/Fine Layer ❑'/a to 1' ❑ > 1'
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ %a to 1" ❑ > 1"
Comments
Date: S /0 I /2002 Inspection Team: Name: __ Agency:
Z! 3 1 N Name: Agency:
NYC-WTC 000114585
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NYC-WTC_000114585Source: NYC Law Department, mirrored locally