NYC 9/11 Public Portal Document
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WTC Visual survey Form IOU(n2?/
Premise Address: , 1
i
Block: j4 I Residential p 1CommerciaI p Name of Bu di g:
Lot: IC I Mix Use JJ Other
# of Stories: AKA's: - J
Building Owner/Ma ge ent: Telephone r
Name: '/0 FAX:
Address: 73 7/adIA1
On Site Contact C
Name: 0 Q Telephone Number.
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No p ,,
General Clean Up ❑ Yes [] No Locations: A) GMW`
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes [] No Locations:
Copies of All Reports and Data Requested p Yes
Visual inspection Results:
Facade:
Inspected Debris
North [V/A ❑ No O No Visible/Fine Layer ❑ % to 1" 0>1"
South ❑ N/A h7es: No o Visible/Fine Layer 01410 1" 0>1"
East [.N/A ❑Ye No O Visible/Fine Layer 'vatol"
No 0>1"
West 0 N/A [,rtes No Gto Visible/Fine Layer ❑Yato1" 0>1"
Facade Description:
Roof
Debris: Q1o Visible /Fine Layer [] % to 1" 0> 1"
Description: , I l n
Setbacks N/A J"
Floor Debris: ❑ No Visible/Fine Layer El14 to 1" 0>1"
Floor. Debris: No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: [3 No Visible/Fine Layer 034101" [] >1"
Floor Debris: No Visible/Fine Layer ❑ % to 1" 0>1"
Floor. Debris: No Visible/Fine Layer L]'f to 1" 0>1"
Comments
Date: Inspection Team: Name: Agency: V
C
Name: Agency:
NYC-WTC- 000116753
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