NYC 9/11 Public Portal Document
WTC Visual Survey Form I n0c 9 2 •7
Premise Address: T
If
Block: Residential 0 Commercial Name of Building:
Lot: Mix Use J Other ' s,
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: T} t/ `r, 'nj FAX ( 2/Z 7 _ 53,
Address: x7 3 4 -z.i é7— 740. x '3 /
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 Kesuits:
Facade:
Inspected Debris
North ❑ N/A Yes ❑ No
n
❑ No Visible/Fine Layer ❑Y2to1" 0>1"
South ❑ N/A 0 Yes ❑ No Z Ne-Visible/Fine Layer ❑Y2tol" 0>1"
East ❑ N/A ® Yes ❑ No No-Visible/Fine Layer ❑%2to l" 0>1"
West ❑ N/A E) Yes ❑ No Ne istbleIFine Layer ❑Y:tot" 0>1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ( Y2 to 1" [J>1"
Description: t P '"
nrz d , fc' -ndied .
Setbacks N/A z
Floor. 3 Debris: ❑ No Visible/Fine Layer 181'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
V- 4
Date: ❑12- 2- 2002 Inspection Team: Name: i2 R f/ Agency: $ ;
Name: Agency:
f .S"Il
NYC-WTC 000118622
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