NYC 9/11 Public Portal Document
WTC Visual Survey Form 1 00 0 7
Premise Address:
-d S
Block: 2 Residential D CommercialJ Name of Building:
Lot: Mix Use Q Other
# of Stories: p AKA's:
Building Owner/Management: C, wakfisL1Telephone Number: (2/2-) 42 _ c'5
Name: 1t4oar éç sar FAX:
Address: ,i_ j~ a4 -
On Site Contact: f2f -'Y
Name: " c'~ ~. , c-~ - Telephone Number:
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up jYes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring 1 .Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
visual inspection Kesuits:
Facade:
Inspected Debris
North ❑ N/A f Yes ❑ No fa NeVi ible/Fine Layer ❑ % to 1" ❑ > 1"
South ❑ N/A EYes ❑ No E No.Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
East ❑ N/A RYes ❑ No S Na.Visibte/Fine Layer ❑ Y2 to 1" ❑ > 1"
West ❑ N/A [ Yes ❑ No ❑ No ibie/Fine Layer ❑'/2 to 1" ❑ > 1"
Facade Description:
Roof 0n YD
Debris: No Visible /Fine Layer [```,~~^^^~~~ '/2 to 1" ❑ > 1"
Description: ©r) 'Y'at ,to ckQb,- cgb%eYVd.
Setbacks N/A n
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date: ... / 21-"/2002 Inspection Team: Name: R n2d/a't7'/ Agency: n"JG MP.
Name: Agency:
NYC-WTC-000118540
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