WTC Visual Survey Form B4 (00-0:9(3
Premise Address:
MDL) !
yr
a r
Block: 22 Residential p Commercial Name of Building:
,Lot: 'Z Mix Use I J Other ❑
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: FAX:( )
Address:
On Site Contact:
Name: Telephone Number: )
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested ❑ Yes
visual inspection Kesuits:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑Y:to 1" 0>1"
South ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ElY2 to 1" 0>1"
East ❑ N/A ❑ Yes D No o Visible/Fine Layer ❑%to l" 0>1"
West ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑%to 1" 0>1"
Facade Description:
Roof
Debris: Visible /Fine Layer ❑ Y2 to 1" 0>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 ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Comments
Date: ' / : 3 / /2002 Inspection by: Name: A Agency: 4. L t
Name: Agency:
NYC-WTC-000118170
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NYC-WTC_000118170Source: NYC Law Department, mirrored locally
Joint memorandum from NYC DEP and DOH advising building owners on post-9/11 maintenance, re-occupancy issues, and hazardous material assessments including asbestos.