NYC 9/11 Public Portal Document
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d . WTC Visual Survey Form /00337~
asmise Address: — ~
i-ILJC S P(-
Block: Residential J Commercial Name of Building:
Lot: Mix UseD Dtherp
# 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 ❑ Yes No Locations:
ACM Clean Up ❑ Yes 0 No Locations:
Air Monitoring ❑ Yes 0 No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North Q N/A ❑ Yes Q No No Visible/Fine Layer % to 1" 0> 1"
South a N/A Q Yes 0No No Visible/Fine Layer % to 1 0>1*
East N/A Yes ❑ No 0 No Visible/Fine Layer % to 1 D> 1"
West N/A Yes o ❑ No Visible/Fine Layer ❑ Va to 1" 0>1*
Facade Description: ^ _ V r,
Roof
Debris: o Visible /Fine Layer .914 to 1*
Description:
Setbacks N/A
Floor: Debris: D No Visible/Fine Layer % to? D>1
Floor____ Debris: a No Visible/Fine Layer % to 1' >1'
Floor Debris: No Visible/Fine Layer % to 1' > 1'
Floor____ Debris: No Visible/Fine Layer h to 1' >1.
Floor____ Debris: No Visible/Fine Layer 14 to? > 1*