WTC Visual Survey Form
Premise Address:
a0 1
Stock: Residential J Commercial J Name of Building:
Lot: Mix Use 0 Other
# of Stories: AKA's:
Building Ow er/Manage ent: 7s .. Telephone Number: ( )
Name: ~. /n G 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 Al! Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Yz to 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1"
East ❑NIA ❑Yes❑No ❑ No Visible/Fine Layer ❑ % to 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1"
Facade Description:
Fyn4...._ Ln.'tews 4i S
Roof
Debris: o Visible /Fine ayer ❑ % to 1" •1 ' ❑ > 1" '~ .i,t .
Description:
Setbacks N/A
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Ya to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ h to 1" ❑ > 1"
Date Inspection Team: Name: T\ '— Agency:
ENTERED Name: Agency:
NYC-WTC 000115461
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NYC-WTC_000115461Source: NYC Law Department, mirrored locally
Department of Environmental Protection inspection form for WTC-area building documenting facade condition, asbestos, and other environmental hazard assessments.
Department of Environmental Protection inspection form for WTC-area building documenting facade condition, asbestos, and other environmental hazard assessments.