z 2
'U.
Premise Address:
Block: Residential 0 Commercial Name of Building:
Lot: Mix Use 0 Other
# of Stories: AKA's: a vr. •¢•
Building Owner/Manage ent: Telephone Number: )
Name: 7 tViV, €, FAX: 2/2- 7_53'
Address: xT/ 3 o11 -o. C-acr
On Site Contact:
Name: sr 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 Re uested Yes
visual inspection Kesults:
Facade:
Inspected Debris
North ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer Ej '/2 to 1"
South ❑ N/A ( Yes ❑ No n No-Visibte/Fine Layer [J 1/2 to 1"
East ❑ N/A ❑ Yes O No /Fine Layer ❑ % to 1"
West ❑ N/A J Yes ❑ No N i /Fine Layer ❑ % to 1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ( '/z to 1" ❑ > 1"
Description:
Setbacks N/A R]
Floor 3 Debris: ❑ No Visible/Fine Layer ( '/ to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑%to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑%to1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑%to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑%to l" 0>1"
Date: 2 / 22--/2002 Inspection Team: Name: iR' R/I- '//' N Agency: iVyC D a
Name: Agency:
Dcl. Yet ff g 1 Ob err fM.4
NYC-WTC 000118604
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000118604Source: NYC Law Department, mirrored locally