WTC Visual Survey Form 1001'1D4
Premise Address:
3 2 tr PEM i— sT
Block: 0 Residential Commercial fi Name of Building:
Lot: Mix UseD Other 13i'a K,
# of Stories: 5 AKA's:
Building Owner/Management: Telephone Number: ( )
Name: FAX: )
Address:
On Site Contact:
Name: - Mc. m/ 4iz4 Telephone Number: 2-11437 '1&2-
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up BYes ❑ No Locations: _iyTFl2j A a & T-eRaoR
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested 0 Yes
Visual inspection KesWts:
Facade:
Inspected Debris
North ❑ N/A Yes ❑ No ~$ No Visible/Fine-Lae ❑ Yz to 1"
South SN/A D Yes ❑ No [] No Visible/Fine Layer 0
V to 1"
East O N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1"
West ❑ N/A Yes ❑ No No Visible/F%-Leyef ❑'/ to 1"
Facade Description:
Joint memorandum from NYC DEP and DOH advising building owners on post-9/11 maintenance, re-occupancy issues, and hazardous material assessments including asbestos.
WTC debris inspection form documenting visual inspection results for facade condition, ACM assessment, and building characteristics for a 3-story structure.