WTC Visual Survey Form,
Premise Address: 1 I
~`~\/ \" /
Block: Residential 0 Commercial p kiame of Buil ing:
Lot: Mix Use 0 Other J S u
# of Stories: U AKA's:
Building Own / anagement: Telephone Number: ( )
Name: e Q\ L j FAX:
Address:
On Site Contact:
Name: Telephone Number:
Building Owner Management Activities
Interior Survey Performed ,~" es ❑ No
Exterior Survey Performed [3 Yes ❑ No
General Clean Up,~ Yes ❑ No Locations:
ACM Clean Up Yes No Locations:
Air Monitoring Yes ❑ No Locations:
Copies of All Reports and Data Reguestedt3 Yes
Visual Inspection Results:
Facade: ~.:M •
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 IJ Yes[] No E3No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
West N/A LJYes ElNo No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Facade Description
Roof
Debris: ❑ No Visible /fine Layer g %2 to 1" J> 1"
Description: ç- Sc
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Comments
. ~
Date: I/ /2002 Inspection Team: Name: '- fl I v Agency:
Name: Agency:
NYC-WTC-000116728
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000116728Source: NYC Law Department, mirrored locally