Block: Residential Commercial Name of B lidin
Lot: Mix Use 0 Other E-
# of Stories: / AKA's: i c c -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.
Building Ovimer/Mana ement: lelephone Number:; PII
Name: £ ve k — (/1' FAX: .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.---
Address:
On Site Contact:
Name: ' S~'''~
A-
Building Owner Management Activities
Telephone Number:
Interior Survey Performed [ Yes ❑ No
Exterior Survey Performed ® Yes ❑ No
General Clean Up [Yes ❑ No Locations:
ACM Clean Up ❑ Yes Qfilo Locations:
Air Monitoring [fifes ❑ No Locations:
Copies of All Reports and Data Requested Yes
1
Visual Inspection Results:
Facade:
Inspected Debris
North 'N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %2 to 1" O>1"
South N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ V2 to 1" O>1"
East J N/A Yes Q No No Visible/Fine Layer ❑ Y to 1" O>1"
West ❑ N/A • Yes ❑ No No Visible/Fine Layer ❑ Va to 1" ❑>1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer Y2 to 1" O>1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1"