NYC 9/11 Public Portal Document
WTC Visual Survey Form ►
'Premise Address: eto 1 J\—cT / /
Block: 5 Residential U Commercial p iame of Bullc(ing:
Mix Use 0 OtherEl t~ 1-.-
Lot:
# of Stori s: 1.,O AKA's: .-;n '
Building Own ageme~ t,; Number ( )
Name: e, FAX:
Address:
On Site Contact
Name: • O,*, Telephone Number:
Building Owner Management Activities
Interior Survey Performed ' s ❑ No
Exterior Survey Performed [3Yes ❑ No
Gene bl Clean Up Yes ❑ 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 EYes 0 No No Visible/Fine Layer 34 to 1" ❑ > 1"
South N/A Yes ❑ No No Visible/Fine Layer % to 1" ❑> V
East N/A Yes ❑ No No Visible/Fine Layer 34 to 1" H>1"
st N/A Yes ❑ No o Visible/Fine Layer % to 1" 0>1'
Facade Descrrption:
Roof
Debris: ❑ No Visible ine Layer wo _1"
ZYs t ~,~
Description:
<..
Setbacks N/A ❑
Floor._„_ Debris: No Visible/Fine Layer ❑ Ya to 1" 0>1'
Floor. Debris: No Visible/Fine Layer ❑ % to 1" > 1"
Floor: Debris: No Visible/Fine Layer 34 to 1" B 1"
>
Floor. _ Debris: 0 No Visible/Fine Layer g 34 to 1" > 1"
Floor: Debris: ❑ No Visible/Fine Layer 036101' >1.
Comments
Date: ) I1(12002 Inspection Team: Name: '- Tti L Agency: .J'
Name: Agency:
,,
NYC-WTC- 000116727
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