WTC Visual SMrvey Form
Premise Address: YC
Block: Residential D Commercial JJ Name of Building:
Lot: Mix Use D Other
# of Stories: AKA's: _._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._
Building Owner an gemen Telephone Number
Name: k -Q (n•- iZ FAX: P 11
Address: ,.--------------------------------------------------------------
On Site Contact:
Name: Telephone Number:
Building Owner Management A,ctivlties
Interior Survey Performed es ❑ No
Exterior Survey Performed Q.Yes ❑ No
General Clean Up lees ❑ No Locations:
ACM Clean Up ❑ Yes ❑ Nc7 J.ocattons
Air Monitoring ❑ Yes ❑ No r Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
in pected brie
North ❑ N/A Yes❑No No Visible/Fine Layer ❑ Va to 1"
South /A ❑Yes❑No 0 No Visible/Fine Layer ❑ Va to 1"
East ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ % to 1"
West ❑ N/A Yes ❑ No o Visible/Fine Layer ❑ Va to 1"
Facade Description:
Roof
Debris:
Description~- 0 o Visible ie Layer
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0 % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date: / 1200 Inspection Team: Name: L '' Agency)' L U
Name: Agency:
NYC-WTC—000117298
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NYC-WTC_000117298Source: NYC Law Department, mirrored locally