WTC at Survey Form /05Do /j
Premise Address:
`PAC
Block: jo'7 Residential JJ Commercial j w ame of Building:
Lot: Mix Use Other
# of Stories: AKA's:
Building OwnerlManagement Telephone Number.
Name: FAX:
Address:
On Site Contact
Name: ' ' Telephone Number.
Building Owner Management Activities
Interior Survey Performed Q Yes Q No
Exterior Survey Performed ❑❑ Yes No
General Clean Up ❑Yes No Locations:
ACM Clean Up ❑ Yes No Locations:
Air Monitoring Q Yes Q No Locations:
Copies of All Reports and Data Requested fl Yes
Visual Inspection Results:
Facade:
Inpected Dbris
North es Q No NoVisIbleFFine Layer 914to 1" 0:1-11,
South es No o Visible/Fine Layer h to 1" >1"
East []~~/A es No No Visible/Fine Layer h to 1" > 1'
West Q N/A D Yes Q No No Visible/Fine Layer H%tol" > 1"
Facade Description:
Roof
Debris: U No Visible /Fine Layer .9 3% to 1" 9>1'
Description:
Setbacks NIA 0
Floor. Debris: No Visible/Fine Layer ❑ 36 to 1' ❑ > 1'
Floor. Debris: No Visible/Fine Layer Q . to 1' >1'
Floor. Debris: No Visible/Fine Layer % to 1' > 1'
Floor Debris: No Visible/Fine Layer h to? >1"
Floor Debris: No Visible/Fine Layer Y: to? H301'
Comments
-I
1L1!ri . .
- ENTERED
NYC-WTC 000115026
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NYC-WTC_000115026Source: NYC Law Department, mirrored locally