WTC Visual Survav Form RIJ 160125 '1
Premise Address:
Block: 9 d
sq pay-L
Residential
-Row Name of Building:
D Commercial JJ
Lot: 3 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 Yes
visual Inspection Results:
Facade:
Inspected Debris
North ❑ NIA ❑ Yes ❑ No ❑ No ViSible/Fine Layer ❑ % to 1" []> 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" J>1"
East ❑ N/A ❑ Yes ❑ No ❑ No ViSible/Fine Layer ❑ % to 1" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No ViSible/Fine Layer ❑'/ to l" 0>1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑ % to 1"
Description: _
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No ViSible/Fine Layer ❑ % to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No ViSible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date: )/ 17 /2002 Inspection by: Name: C Agency: DG P
Name: Agency:
NYC-WTC 000115426
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NYC-WTC_000115426Source: NYC Law Department, mirrored locally