WTC Visual Survey Form
PremiseAddr~ss:
(,
Block: Resi entiai Commerci Nei" of Idi g:
Lot: Mix Use Other I L~ sLn,
#of Stories: AKA's:
Building Owner1Jkanagement Telephone Number. (
Name: FAX:
Address:
On Site Contact:
Name: " " ". Telephone Number.
Building Owner Management Activities
Interior Survey Performed ❑ Yes 0 No
Exterior Survey Performed ❑ Yes 0 No
General Clean Up [] Yes [] No Locations:
ACM Clean Up ❑ Yes Q No Locations:
Air Monitoring Q Yes Q No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A Q Yes j] No ❑ No Visible/Fine Layer DYatol" 0>1"
South Q N/A QY'es 0 No Visible/Fine Layer to 1" 0>1"
East Q N/A ❑YesDNo ❑ No Visible/Fine Layer %to l" 0>1"
❑ No Visible/Fine Layer
West Q N/A
Facade Description: 1
.7-- es Q No to1" ❑>1"
Roof
z i'
Setbacks N/A Q
Floor. Debris: Q No Visible/Fine Layer j_]'/ to 1" ❑ > 1"
Floor. Debris: Q No Visible/Fine Layer Q % to 1" 0> 1"
Floor. Debris: Q No Visible/Fine Layer Q % to 1" ❑ > 1"
Floor: Debris: Q No Visible/Fine Layer Q a to 1" 0> 1"
Floor. Debris: Q No Visible/Fine Layer Q h to 1" 0> 1"
Comments
Date: l 12002 Inspection Team: Name: Agency: W
Name: Agency:
NYC-WTC 000117231
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000117231Source: NYC Law Department, mirrored locally
Multi-page form documenting World Trade Center contamination assessment for a residential or commercial building, including facade inspection checklist and environmental testing…
DEP inspection form for 50 Broadway documenting building characteristics, facade conditions, and asbestos-containing material survey across multiple building faces.