DEP Request for Environmental Hazard Assessments, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential EJ Commercial E I Name of Building: Lot: Mix Use ❑ Other ❑ - # of Stories: AKA's: r c.^ Building Own r a agement: Tel phone Number: (2 - ) Name: ti t' r -- i 1 U --r- FAX ( ) Address: On Site Contact:' i ~2 Name: 1 ~. v~ ^ ~w-t -- Telephone Number: (? )h = Sr Building Owner Mana ment Activiti Interior Survey Performed ❑ Yes No Exterior Survey Performed ❑ Ye ` o ~ General Clean Up. d(es Jo ations: ACM Clean Up ❑ Yes. No Locations: Air Monitoring ❑ YesJ No Locations: Copies of All Reports and Data Requested ❑ Yes

Visual Inspection Results: Facade: Inspected Debris North /A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" South N/A ~- ZIYes ❑ No No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1" East ,E'N/AJ a -Yes ❑ No No Visible/Fine Layer ❑'/z to 1" ❑ > 1" West ❑ N/A s ❑ No o Visible/Fine Layer ❑'/2 to " ❑ > 1" Facade Description: ✓ _

Roof f

Debris: ~~Yisible /Fine iyer ❑'/2 to 1" 1 0>1" 1 Description: 7 II

f

Setbacks N/AJ Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"

Comments I ~ i,✓~ ~~~~ ~ ~'--~ -~ 1f #

Date: \//2002 Inspection Team: Name: 1 -t k r cc } -C- , V-~-- Agency: L-' Name: Agency:

NYC-WTC 000118252