B1onk: Residential 9 Commercial Name of Building:
Lot: Mix Use 0 Other
#t of Stories: AKA's:
Building Owner/Management Telephone Number. ( )
Name: C_ {-2~ FAX:
Address:
On Site Contact
Name: " Telephone Number
Building Owner Management Activities
Interior Survey Performed ❑ Yes Q No
Exterior Survey Performed [] Yes E] No
General Clean Up Yes No Locations:
ACM Clean Up Yes No Locations:
Air Monitoring ❑ YesDNo Locations:
Copies of All Reports and Data RequestedIJ Yes
Visual Inspection Results:
Facade:
Inspected Debris
North N/A Yes No No Visible/Fine Layer % to V > 1'
South N/A Yes No No Visible/Fine Layer h to V > 1"
East N/A Yes No No Visible/Fine Layer h to 1" > 1"
West N/A yes No No Visible/Fine Layer % to 1- 9> 1"
Facade Description: f _
Roof
Debris: Mo Visible /Fine Layer [] 34 to 1" 9>1'
Description:
Setbacks N/
Floor:___ Debris: No Visible/Fine Layer % to 1" '1'
Floor Debris: No Visible/Fine Layer 34 to 1" >1'
Floor Debris: No Visible/Fine Layer % to 1" > 1"
Floor____ Debris: No Visible/Fine Layer % to 1" > 1"
Floor. Debris: No Visible/Fine Layer % to 1" > 1'
Comments
Date: / !i ,/2002 Inspection Team: Name¼ Agency: ____
Name: Agency:_______
E N T E R E D
NYC-WTC-000116882
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000116882Source: NYC Law Department, mirrored locally