NYC 9/11 Public Portal Document
7
WTC Visual Survey Form
Premise Address: n
Block: I Residential 0CommercjaD I Name of B ilding: ~t
Lot: Mix Use ❑ Other I \ \ s- ._
# of Stories: I AKA's:
Building.Qwner/Manag ent: -~= Telephone Number: (Lt ) a4-~ 4
Name: A. emu. _E . t6, E5 1 C c- FAX: (
Address: /
On Site Contact:
Name: fr^ , ' " `0 T ephone 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: ~I
Air Monitoring _ 'es ❑ No Locations:
Copies of All Reports and Data Requested es
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A E .Yes ❑ No '-gNo Visible/Fine Layer D% to 1" 0>1"
South ❑ N/A 'Yes ❑ No [ No Visible/Fine Layer 0%to 1" ❑ > 1"
East ❑ N/A L Yes ❑ No [ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
West ❑ N/A QYes ❑ No Q No Visible/Fine Layer 0% to 1" 0>1"
Facade Description: , I
Roof ~,'-•t
/
Debris: Visible /Fine ta
ayyer ❑'/ to 1" •1 ❑ > 1" 1 {'"'4
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 / ,~ ! ? —
c.~ - L-'
,& r
r
Date: )_/ '2- ~L/2002 Inspection Team: Name: C +7 l tgency: n f
Name: Agency:
NYC-WTC- 000118243
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