NYC 9/11 Public Portal Document
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WTC VIS,6if Survey Form
Prerraise Add :
Block: Residential CorLèiaJ Name of Building:
Lot: Mix UseD Other
# of Stories: 2. AKA's:
Building Owner/Management Telephone Number ( )
Name: N c FAX:
Address:
On Site Contact:
Name: ' ' Telephone Number.
Building Owner Management Activities
Interior Survey Performed ❑ Yes No
Exterior Survey Performed [] Yes j] No
General Clean Up Yes No Locations:
ACM Clean Up Yes No Locations:
Air Monitoring ❑ Yes 9 No Locations:
Copies of All Reports and Data Requested Yes
visual inspection Results:
Facade:
Inspected Debris
North [] N/A 9 Yes No No Visible/Fine Layer 014 to 1' > 1'
South ❑ N/A 9 Yes No No Visible/Fine Layer 14 to? > 1'
East N/A 9 Yes No No Visible/Fine Layer 14 to 1" > 1'
West J N/A J j Yes No No Visible/Fine Layer 14 to 1' 9>?
Facade Des ption:
Roof
Debris: 0 No Visible /Fine Layer [] 14 to 1' [J>1'
Description:
Setbacks N/A,
Floor Debris: No Visible/Fine Layer % to 1' > 1'
Floor____ Debris: No Visible/Fine Layer % to 1' > 1'
Floor Debris: No Visible/Fine Layer 14 to 1' > 1'
Floor. Debris: No Visible/Fine Layer 34 to1' >1'
Floor Debris: - No Visible/Fine Layer % to 1' > 1'
Comments
Date: _4- i2.7 12002 inspection Team: Name: J .. S11G , R. a (MkAgency: O
Name: Agency:
N TE~ EQb
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NYC-WTC 000117173
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NYC-WTC_000117173Source: NYC Law Department, mirrored locally