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Premise Addr :
.:: ... .:
-®ck:
. ..:
Residential
17
Commercial
wp.. Name of Building:
4 Mix _.
Lot 3 Use 0. Other 0
# of Sto es: AKA's:
Building OwneriManagement: Telephone Number. (
Name: EAR:
Address:
On Site coonttaict
Name: Telephone Number:
Building Owner Management Activities
Interior Survey Performed ❑ Yes [] No
Exterior Survey Performed ❑ Yes [] No
General Clean.UpQ Yes [] No Locations:
ACM Clean tip': 1JYes [] No Locations:
Air Monitoring ❑'Yes❑ No Locations:
Copies of All Reports and Data Requested 0 Yes
Visual Inspection Results:
Facade:
inspected Debris
North []NIA 0 Yes ❑ No ❑ No Visible/Fine Layer fijY2tol" 0>1"
South [] N/A ❑ Yes Q No ❑ No Visible/Fine Layer '/ to 1" 0>1"
East ❑ N/A ❑ Yes Q No ❑ No Visible/Fine Layer %2 to 1" 0>1"
West ❑ N/A ❑Yes0 No ❑ No Visible/Fine Layer % to 1" 0>1"
Facade Description: