Block: Residential El Co t*1 a cal I Name of Building:
Lot: Mix Use ❑ Other. i ( l., wck4. .- -ç ).J\-c / 1- _ l-
# of Stories: AKA's:
Building Owner/Mang ment: Telephone Number: (
Name: \'\\\e o eo FAX: ( )
Address:
On Site Contact:
Name: " Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No l
Exterior Survey Performed ❑ Yes ❑ No ? v I~
General Clean Up ❑ Yes ❑ No ocations:__________________________________________
L at ons.
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 es ❑ No ~ .No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
South ❑ N/A . Yes ❑ No No Visible/Fine Layer ❑'/2 to 1" £3> 1"
East ❑ N/A [Z Yes ❑ No No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West ❑ N/A QYes ❑ No No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Facade Description:
Roof ~5t
Debris: .No Visible /Fine r fl '/z to 1" •1 f- 1> 1" '1 {~ '~
Setbacks N/AJ
Floor: Debris: INo Visible/Fine Layer El /2 to 1" 0>1"
Floor: Debris: No Visible/Fine Layer £3 '/2 to 1" ❑ > 1"
Floor: Debris:. No Visible/Fine Layer ❑ Y2 to 1" ❑ 1"
Floor: Debris: No Visible/Fine Layer ❑ Y2 to 1" 0>1"
Floor: Debris:ZJ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Comments
Date: / /2002 Inspection Team: Name: Agency: C
Name: Agency:
S'
NYC-WTC 000116697
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NYC-WTC_000116697Source: NYC Law Department, mirrored locally