WTC Visual Survey Form
Premise Address:
Block: Residential 0 CommercF Name of Building:
Lot: Mix Use 0 Other p CMG a
# 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 Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
South ❑ N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
East ❑ N/A ❑Y s❑No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West ❑ N/A es❑No No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Facade Description:
Roof
Debris: o Visible /Fine Layer Ya to 1" `' - 0>10
Description: A
Setbacks NIA ❑
Floor: Debris: ❑ No Visible/Fine Layer 0
Y 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 ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
T
Date: u / / "/2002 Inspection Team: Name: `--
-'
' "
h Agency:
Name: Agency:
NYC-WTC-000118612
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NYC-WTC_000118612Source: NYC Law Department, mirrored locally