WTC Visual Survey Form
I Prerr4eó Address:
~1!DE 97F- 5T
Block: 15 Residential Commercial J Name of Building:
Lot: Ip Mix Use 0 Other
# of Stories: S 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
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A Yes ❑ No 'No Visible ❑ 1/2 to 1" 0>1"
South ❑ NIA 'Yes ❑ No 0 No Visible ❑ % to 1" 0>1"
East ® N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
West N/A ❑ Yes ❑ No [] No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Facade Description:
Roof
Debris: No Visible ❑ Y to 1" L] > 1"
Description: 2Z ~. -y `Z P cx~ibc
Setbacks N/As
Floor. Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ Y. to V ❑ > 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"
Comments
Date: 4- _/x/2002 Inspection Team: Name: .@ - nw h Agency: DAP-
~ NT +ER o Name: Agency:
NYC-WTC-000115000
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000115000Source: NYC Law Department, mirrored locally