WTC Visual Survey Form 10 7711 R T
Premise Address: ~•'
A S7EL; 7
Block: I5d Residential Commercial 9 Name of Building:
Lot: Mix UseD Other
# of Stores: '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 VisibleF yef ❑tot" ❑>1"
South ❑ NIA Yes ❑ No No Visible ❑Mato l" 9>1"
East J N/A ❑ Yes ❑ No ❑ No VSible/Fine Layer ❑Yto1" 9>1"
West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Vato1" 9>1"
Facade Description:
Roof
Debris: No Visible 1 s V to 1" ❑ > 1"
Description: i2 12 ct.T)G c ti-
Setbacks N/A s
Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No VSible/Fine Layer ❑ h to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1"
Comments
Date: 4/x12002 Inspection Team: Name: 4? -7.7 rt-w 67 Agency: ! CP-
o Name: Agency:
D NS E~ .
NYC-WTC-000115003
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000115003Source: 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.