WTC Visual Survey Form 100!é 3q
Premise Address:
6 R&Ai
Block: I 50 Residential 0 Commercial Name of Building:
Lot: Mix Use j 1 OtherI J
# of S ories: AKA's:
Building Owner/Management: /- Jay c1, Telephone Number. (zj ) g-ev _ e sb8
Name: J 1IaM k FAX:
Address:
On Site Contact:
Name: S Telephone Number:
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes 0 No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring j] Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
visual inspection Results:
Facade:
Inspected Debris
North ❑ N/A EfYes ❑ No ® No Visible DYtol" ❑>1"
South N/A ® Yes ❑ No ® No Visibl r ❑htol" 0>1"
East fNIA ❑ YesD No ❑ No Visible/Fine Layer ❑%tor 0>1"
West N/A ❑Yes❑No [J No Visible/Fine Layer []'/: to 1' ❑ > 1"
Facade Description:
Roof
Setbacks N/A10
Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1' 9>1
Floor. Debris: ❑ No Visible/Fine Layer 9 4 to 1' 9> 1'
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer ❑ 6 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1'
Comments
Date: I r,Oo21 E 1) Inspection Team: Name: R Agency:
Name: Agency:
NYC-WTC 000114985
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NYC-WTC_000114985Source: NYC Law Department, mirrored locally
Checklist form documenting building characteristics, facade visual inspection results, and asbestos presence assessment at 196 Broadway for post-9/11 environmental evaluation.