NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
Block: Residential Commercial J J Name of Building:
Lot: Mix Use Other
# of Stories: AKA's: -E' c -t/N C R,lcc
Building OwnerlManagement: L ~c, , m R . Telephone Number: (2C z.) 94 _ z
Name: TERZ-- FAX:
Address:
On Site Contact:
Name: R .- Ant , i ., , S-Pi)T 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: ON ROOF :T Ng r3, ptoua/f7 .
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
r{-rUdl If15~?CL LtUtI rwDUII .
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %z to 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %z to 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %z to 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1"
Facade Description:
Roof
Debris: ff No Visible /V , ❑ V2 to 1" ❑ > 1"
Description: ran LfiS1E,_c dEpZiS f S
Setbacks N/AR
Floor. Debris: ❑ No Visible/Fine Layer % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Comments
Date: 7 / 1C 12002 Inspection Team: Name: ,4 H Agency: N'-j bEP
Name: Agency:
`F NTERF
NYC-WTC-000118629
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