NYC 9/11 Public Portal Document
WTC Visual Survey Form, ()
Premise Address:
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-, gyp
c/
\I.PamKa of/Bull ing:
Block: ResidentialU Commercial
U J
Lot: MixUse Other t7
# of Stories: 1O AKA's:
Building Own anagement: Telephone Number: ( )
Name: fLQI )J?,"" çQJ\ '>-' rj FAX:
Address:
On Site Contact
Name: `Qt)L Telephone Number:
Building Owner Management Activities
interior Survey Performed es ❑ No
Exterior Survey Performed [Yes ❑ No
Geneldl Clean Up J 1es ❑ No Locations:
ACM Clean Up Yes.®,No Locations:
Air Monitoring Yes ❑ No Locations:
Copies of All Reports and Data Re uested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North N/A Yes ❑ No .No Visible/Fine Layer []'% to 1" ❑ > 1"
South N/A Yes ❑ No JNo Visible/Fine Layer D% to 1" 0>11
East
West
Facade Descr
" N/A
N/A
ption:
j Yes ❑ No
Ujyes ❑ No Mo o Visible/Fine Layer f 1 'A to 1"
Visible/Fine Layer ❑Y:to 1"
❑ > 1"
❑ > 1"
Roof
Debris: 0 No Visible/Fine Layer. A c ,g'/ to 1" fl > 1"
Description: )f.4t "L; e
Setbacks N/A 0
Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'4 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date:„,/ /2002 Inspection Team: Name: Agency:
Name: Agency:
NYC-WTC-000116723
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