F WTC Visual Survey Form 1000$S(o
Preine ddress:
7 . ?
Residential1J Commercial
'
Block: 29 Name of Building:
Lot: jj Mix UseD Other
# of S s: AKA's:
Building Owner/Management Telephone Number. ( )
Name: FAX:
Address:
On Site Contact
Name: " ' Telephone Number.
Building Owner Management Activities
Interior Survey Performed
Exterior Survey Performed
Yes No
Yes No
General Clean Up ❑ Yes No Locations:
E]
ACM Clean Up ❑ Yes No Locations:
Air Monitoring nYes No Locations:
Copies of All Reports and Data Requested J Yes
Visual Inspection,Results:
Facade:
Inspected Debris
North j] N/A ❑ Yes Q No No Visible/Fine Layer t]%to1" 0>1"
South D N/A
East
West
N/A
N/A
DYes No
Yes No
Yes No
No Visible/Fine Layer 34 to 1"
No Visible/Fine Layer ❑%to1"
No Visible/Fine Layer ❑ 6 to 1"
8:01
0>1" 0
0>1"
Facade Description: M
Roof
Debris: t risibIe /Fine Layer D Y. to 1" 9>1"
Description:
Setbacks NFA
Floor___
Floor.
Floor.
Debris:[] No Visible/Fine Layer
Debris: No Visible/Fine Layer H%tol,
3% to V
Debris: No Visible/Fine Layer 934 to 1"
Floor____ Debris: No Visible/Fine Layer =] 3 to 1"
Floor Debris: No Visible/Fine Layer F] % to V
Comments
Date: 9 i Ej9 R/2002 inspection Team: Name: Agency:
Name: Agency:
E
EN T
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NYC-WTC 000116825
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NYC-WTC_000116825Source: NYC Law Department, mirrored locally