NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
Block: Residential 0 Commercial Name of Building:
Lot: Mix UseD 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 fl Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to I . ❑ > 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Ya to 1" 0>1*
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑ Va to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ %i to V ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'%s to V ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'h to 1" ❑ >V
Comments
A/ o A ec . e S ~C nl2 y cal N 6.c ~, ~ ~' g l As f ;2 sic u ,e, C„A,raa
Date t3 l- 3 . !2002 Inspection Team: Name: -v4
/h Nom` Agency: z -T_ p
Name: Agency:
NYC-WTC 000118403
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