WTC Visual Survey Form
Prer.. se Address
22 kP -
Block: Residential 0 Commercial. Narn,e of Buildin :
Lot: 14 Mix Use ❑ Other VA -- f
# of Storie : AKA's: j2 .
Buildin wn r/M agement: )Telephone Number: (2i L) 30
Name: w V~ FAX:
Address:
On Site on C. J~a\re-w
Name: " ~k Telephone Number: ) 3Ut - 6G3
Building Owner ManagementçActivities
Interior Survey Performed es ❑ No
Exterior Survey Perfo ed Yes ❑ No
General Clean Up 1 Yes ❑ No Locations:
ACM Clean Up ❑ Yes 'o Locations:
Air Monitoring ❑ Yes No Locations:
Copies of All Reports and Data Requested es
Visual Inspection Results:
Facade:
Inspected Debris
North N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1'
South VN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" 0>1"
East N/A Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 1"
West ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" > 1"
Facade Description: - .
Roof ~,sr
u "1 ={_44
Debris: ❑ No Visible /Fine ayer ❑ % to 1" •1 `-"' > 1"
Description: 1 I
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer ❑ Y 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 0 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"