WTC V!sual Survey Form
Premise Address:
Block: R I ntial 0 mm, rcial13 Name of Building:
Lot I MbcUsefJ Other
# of Stories: AKA's:
Building Owner/Management Telephone Number. ( )
Name: FAX:
Address:
On Site Contact:
Name: ' ' Telephone Number.
Building Owner Management Activities
Interior Survey Performed ❑ Yes Q No
Exterior Survey Performed ❑ Yes No
General Clean Up DYes No Locations:
ACM Clean Up Yes No Locations:
Air Monitoring Yes No Locations:
Copies of All Reports and Data RequestedD Yes
Visual Inspection Results:
Facade:
Ins cted Debris
H%toll
North B'N/A es No o Visible/Fine Layer h to 1" > 1'
South N/A es No 44o Visible/Fine Layer y4 to 1' > 1"
East N/A Yes No No Visible/Fine Layer h to 1" >1'
West N/A Yes No No Visible/Fine Layer D> 1"
Facade Description:
Roof
Debris: io Visible /Fine Layer .D % to 1" U > 1'
Description:
Setbacks N/A 0
Floor: Debris: No Visible/Fine Layer 34 to V > 1'
Floor____ Debris: No Visible/Fine Layer 34 to 1' > 1'
Floor Debris: No Visible/Fine Layer Ys to 1' > 1'
Floor Debris: No Visible/Fine Layer Ys to V >1'
Floor___ Debris: No Visible/Fine Layer 34 to 1' > 1"
Comments
Date: 12012002 Inspection Team: Name: Q rsJeA&d Agency:
E E Name: Agency:
R o
• irOMlhI'
NYC-WTC-000116896
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000116896Source: NYC Law Department, mirrored locally
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 141 Greenwich Street dated February 12, 2002.