WTC Visual Survey Form
Premise Address: _-~j , f N ~ i s
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Block: Residential D Commercia Name of Building:
Lot: Mix Use D Other
# of Stories: AKA's:
Building O er/M ement: Telephone Number: ( 2-1 y C' p1
Name: ' FAX:
Address:
On Site Contact: ç
Name: Telephone Number: ( )
Building Owner Management A tivities
Interior Survey Performed es ❑ No
Exterior Survey Perfo ed Yes ❑ No
General Clea U Yes 0 No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring es ❑ No Locations: jr
PV1 Copies of All Reports and Data RequestedQj Yes
I
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
East ❑ N/A 2 Yes ❑ No >Vo Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West ❑ N/A a Yes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Facade Description:
Roof
Debris: No Visible /Fine Layer ❑'/2 to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Building exterior inspection form documenting assessment of debris and deposits on facades and roofs with directional orientation and size measurements.
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 141 Greenwich Street dated February 12, 2002.