Premise Address:
WTC Visual Survey Form V-9
2 /3 , ,,,j
Block: Residential 0 Commercial 9 Name of Building:
Lot: 5 Mix UseD 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 ❑ 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 J Yes
Visual inspection Results:
Facade:
Inspected Debris
North taN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 9>1"
South E N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ h to 1" 0>1"
East ❑ N/A ® Yes ❑ No No Visible/Fine-Layer ❑ % to f 0>1"
West I' N/A [] Yes ❑ No 9 No Visible/Fine Layer ❑ Va to 1" 0>1'
Facade Description:
Roof c# e.'- wibc. d
Debris: /a to 1" 0>1"
Description: isspecled -P -vi l oK r. ! ~2af -'
Setbacks N/A I
Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" 0>1"
Floor Debris: ❑ No Visible/Fine Layer fl 34 to 1" 0>1"
Floor Debris: ❑ No Visible/Fine Layer ❑ i4 to 1" 0>1"
Floor. Debris: ❑ No Visible/Fine Layer [j 36 to 1" ❑>1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1" 0>1"
Comments
Date: /x/2002 Inspection Team: Name: < O w Agency: ♦ OW
Name: Agency:
NYC-WTC-000115249
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NYC-WTC_000115249Source: NYC Law Department, mirrored locally