Block: R sidenti Co merciat D Name of Building:
Lot: Mix Use 0 Other
# of Stories: 3 1 AKA's:
Building Owner/M nagemenly: Telephone Number. (2 t z) S"'c L. $
Name: w ~' FAX:
Address:
On Site Contact:
Name: " ' Telephone Number.
Building Owner Management )ctivftles
interior Survey Performed QYes No
Exterior Survey Performed VesH] No
General Clean Up ❑ Yes U No Locations:
ACM Clean Up Dyes Jo Locations:
Air Monitoring Yes No Locations:
v Copies of All Reports and Data Reguesteçl Yes
Visual Inspection Results:
Facade:
ipppected Debris
North N/A s ❑ No No Visible/Fine Layer ❑%to1" 0>1"
[J Yes ❑ No ❑ No Visible/Fine Layer
South bRN/A
East
West
[3 N/A
'JAVA
Mes ❑ No
❑ Yes[] No
11'io Visible/Fine Layer R
'/to1" >1"
Mato 1" Lj > 1"
f] No Visible/Fine Layer ❑%to 1" 0>1"
Facade Description:
Roof
Debris: j,No Visible /Fi Layer fl % to 1" ❑ > 1"
Description: 2j S , il ' 9
Setbacks N/A[]
Floor. Debris: [] No Visible/Fine Layer 0 4 to 1" 0>1"
Floor. Debris: 0 No Visible/Fine Layer ❑ ~4 to 1" 0>1"
Floor. Debris: No Visible/Fine Layer ❑ i4 to 1" 0>1"
Floor. Debris: No Visible/Fine Layer ❑'/to 1" 0>1"
Floor. Debris: ❑ No Visible/Fine Layer [] 34t0 1" 0>1"
Comments