WTC Visual Survey Form
Premise Address: C,y
Block: R sidentiaiD Commercial p Name of Building:
Lot: Mix Use J Other
# of Stories: AKA's:
Building Qjer/Manaenept:1 Telephone Number: ( )
Name: 0, 4' l-- FAX:
Address:
On Site Contact:
Name: ' ' Telephone Number:
Building Owner Management Activities
Interior Survey Performed es ❑ No
Exterior Survey Performed es ❑ No
General Clean Up esD No Locations:
ACM Clean Up E Yes ❑ No Locations:
Air Monitoring es ❑ No Locations:
Copies of All Reports and Data Re uested es
Visual Inspection Results:
Facade:
- In pected Debris
❑ N/A Yes ❑ No ❑ 4 to 1"
j
North No Visible/Fine Layer ❑ > 1"
South ❑ N/A f Yes[] No o Visible/Fine Layer ❑ % to 1" ❑ > 1"
East ❑ N/A BYes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1"
West ❑ N/A es ❑ No [ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Facade Description:
Roof
Debris: ' ' No Visible /Fine Layer ❑ % to 1" ❑ > 1"
Description: _
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ 4 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑%% to? 0>?
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1"
Comments
DEP inspection form for 50 Broadway documenting building characteristics, facade conditions, and asbestos-containing material survey across multiple building faces.