WTC Visual Survey Form
Premise Address: ~~
o' vI't.
Block: Resident' Commercial Na e o Building:
Lot: /w " Mix Use 0 Other
# of Stori s: AKA's: 3j ,
Building Owner/ani}gem pt: Telephone Number: (2.1)-) -1 l 2-S' D °
Name: o - FAX:
Address:
On Site ContactQ
Name: ' * —X C '~ e phone Number:
Building Owner Managemen ctIvlties
Interior Survey Performed Yes ❑ No
Exterior Survey Perfor fled es ❑ No
General Clean Up es D No Locations:
ACM Clean Up Yes [] No Locations:
Air Monitoring s ❑ No Locations:
Copies of All Reports and Data Requested p Yes
Visual Inspection Results:
Facade:
Inspected De ris
North ❑ N/A Yes ❑ No o Visible/Fine Layer ❑%to 1" 0>1"
South ❑ N/A Yes ❑ No o Visible/Fine Layer ❑Yato1" 0>1"
East ❑ N/A j es ❑ No o Visible/Fine Layer 0%to1" 0>1"
West ❑ N/A 5Yes [] No tNo Visible/Fine Layer ❑%a to 1" 0>1"
Facade Description:
Roof
Debris: Vo Visible /Fine Layer ❑'/ to 1" ❑ > 1"
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer []'/a to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ a to 1" 0> 1"
Comments
Date: /„_,I /12002 Inspection Team: Name: C FI r Agency: ( 1'
Name: Agency:
NYC-WTC- 000116104
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NYC-WTC_000116104Source: NYC Law Department, mirrored locally
DEP inspection form for 50 Broadway documenting building characteristics, facade conditions, and asbestos-containing material survey across multiple building faces.