WTC s Isugi1 Survey Form
Premise Address: r€~
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Block: Residential 9 Commercial Name of Building:
Lot: Mix Use 0 Other
# of Stories: AKA's:
Building Owner/Management Telephone Number. ( )
Name: FAX:
Address:
On Site Contact:
Name: ' ' Telephone Number.
Building Owner Management Activities
Interior Survey Performed ❑ Yes D 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 DYes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A fl Yes No No Visible/Fine Layer 9 3 4 to 1' D>1
South [ es No No Visible/Fine Layer %to V ❑> 1'
East es No No Visible/Fine Layer h to 1 0>1'
West ❑ N/A 9Yes No No Visible/Fine Layer ❑Yto1' ❑>1'
Facade Description:
Setbacks N/AL]
Floor: Debris: No Visible/Fine Layer ❑ % to 1' > 1'
Floor: Debris: No Visible/Fine Layer [] 4 to V >1'
Floor: Debris: No Visible/Fine Layer 4 to 1' > 1'
Floor: Debris: No Visible/Fine Layer % to 1' > 1'
Floor: Debris: No Visible/Fine Layer 36 to 1' g > 1'
Comments
Date: I " W 12002 Inspection Team: Name: Agency:
ENTERED Name: Agency:
NYC-WTC 000115022
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000115022Source: NYC Law Department, mirrored locally