Premise Address:. -
WTC Visual Survey F
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Block: Residential Commercial N me of Building:
Lot: Mix Use Other
# of Stories: AKA's: $ l - i b ad. - t $ i (:-'- 9r q1 w~ ~.-
Bufiding Owner/Management Telephone Number. ( p
Name: ~.t ~vL€. ~~~,, 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 ❑ No Locations:
Air Monitoring j] Yes j] No Locations:
Copies of All Reports and Data Requested Yes
Visual inspection Results:
Inspected Debris
North j] N/A ❑ Yes O No ❑ No Visible/Fine Layer =] % to 1' 9> 1"
South D N/A Yes No 0 No Visible/Fine Layer D 3~4 to 1' 0>1'
East ❑ NIA Yes No [] No Vsible/Fine Layer [] h to 1" 0>1'
West DNIA 9 Yes ❑ No 0 No Visible/Fine Layer ~] 3/ to 1'
Facade Description: (Q J) JJ > 1'
Roof
Debris: o Visible /Fine Layer j] 3~4 to 1' 9>1'
Description:
Setbacks NIA
Floor. Debris:DNo Visible/Fine Layer j] 34 to 1' >1'
Floor. Debris: j] No Visible/Fine Layer j] 4 to V >1'
Floor.____ Debris: ❑ No Visible/Fine Layer 3+4 to 1' >1'
Floor____ Debris: j] No Visible/Fine Layer % to V >1'
Floor Debris: L] No Visible/Fine Layer 34 to 1' >1'
Commen s