V WTI-Visit Survey Form
Premise Address:
Block: 74. Residenti Commercial jJ Name of Building:
Lot: Mix Use 9 Other
# of Stories: AKA's:
Building Telephone Number. {Z Z )
Name: Owner/ManagemenL L•-e X FAX: Z
Address:
On Site Contact:
Name: ' ' Telephone Number.
Building Owner Manage ent Activities
Interior Survey Performed Yes No
Exterior Survey Performed ~J Yes No
General Clean Up ❑ Yes ❑ No Locations:
~]
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring 9 Yes ❑ No Locations:
Copies of All Reports and Data Requested D Yes
Visual Inspection Results:
Facade:
n pected Debris
North [] N/A Yes No No Visible/Fine Layer %tot' 9>10
South ❑ N/A es [] No No Visible/Fine Layer D34to1' 0>10
East ❑ N/A YesQNo No Visible/Fine Layer 34to1' >1'
West ❑ N/A No No Visible/Fine Layer H%tolu 9>1'
Facade Description:
Roof 4
Debris: ' Visible /Fine Layer L] % to 1' 9>10
Description: t
Setbacks N/A0
Floor: Debris: No Visible/Fine Layer 34to 1' >10
Floor: Debris: No Visible/Fine Layer H] 34 to 1' >10
Floor____ Debris: No Visible/Fine Layer 34 to 1' >10
Floor. Debris: No Visible/Fine Layer !h to 1' >10
Floor. Debris: No Visible/Fine Layer 36 to 1' > 10
Comments
Date: l Inspection Team: Name: Agency:
EN *ER Name: Agency:
NYC-WTC 000117027
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000117027Source: NYC Law Department, mirrored locally