WTC Visual Survey Form Q 0 I Z-7 1.,
Premise gddress: 35 A
0'1 - IOg /U~ ~,
Block: Residential Commercial p Name of Building:
Lot: Mix Use D 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 ❑ N/A ❑ Yes ❑ No []No Visible/Fine Layer to1" ❑>1"
South ❑ N/A ❑ Yes ❑,No ❑ No Visible/Fine Layer X to1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer to 1" > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer to1" ❑>1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer /2 to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑'/% to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Comments
Legal agreement between the City of New York and a landowner regarding the removal of foreign material from exterior areas near the former World Trade Center site.