WTC Visual Survey Form ! 0 0 l Coo ()
r
Premise Address: .
p& -72 !Z€—ADr Ar-A 2- .T+vte S ~
Block: M50 ResidentialQ Commercialp Name of Building:
Lot: MixUseD Other
# of Stories: AKA's: I Z Dv 7 S
Building Owner/Management: ,?2 Ova A o. u Telephone Number. (2/1) 6 / q_ 06-f-
Name: La..0 i $ .,,,-+ ►i k FAX:
Address:
On Site Contact
Name: " J v e,o ..SV 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
visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A EYes ❑ No No visible ❑ 1/ 2 to 1" 0>1"
South ❑ N/A EYes ❑ No MNo Vsible r ❑ %to 1" 0>1"
❑ Ya
East
West 0N/A
N/A
Facade Description:
Yes 0 No
D Yes ❑ No
ENoVsible/Fine Layer to 1"
L] No Visible/Fine Layer ❑ a to 1"
❑ > 1"
0> 1"
Roof
Debris: 2g No Visible ❑ 1/ to 1" D> 1"
Description:
Setbacks N/A j
Floor. Debris: ❑ No Visible/Fine Layer 0V to 1' ❑ > 1"
Floor. Debris: 0 No Visible/Fine Layer L] %a to V ❑ > 1'
Floor. Debris: ❑ No Visible/Fine Layer ❑'a to 1' 0> 1'
Floor. Debris: [J No Visible/Fine Layer ❑ % to 1' ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1' _] > 1"
Comments
Date: / /0 /2002 Inspection Team: Name: R bYr1) 1 o ha^'i Agency: . .
Name: Agency:
ENTERED
NYC-WTC 000114990
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NYC-WTC_000114990Source: NYC Law Department, mirrored locally