NYC 9/11 Public Portal Document
V., rmise Address:
WTC Survey Form Ia74,v3
Block: Residential Commercial Name of Building:
Lot: MixUseD Other
of Stores: AKA's:
Building Owner/Management Telephone Number. ( )
Name: GCa ic FAX:
Address:
On Site Contact
Name: " Telephone Number
Building Owner Management Activities
Interior Survey Performed ❑ Yes Q No
Exterior Survey Performed [] Yes [] No
General Clean Up ❑ Yes 0 No Locations:
ACM Clean Up 9 Yes 0 No Locations:
Air Monitoring jJ Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
tns ected Debris
es Q No ` o Visible/Fine Layer > w
North
South
East
o
9"N4k
[] N/A
EVes ❑ No
D Yes D No
~~ No Visible/Fine Layer D %to1w•
O No Visible/Fine Layer 34 to 1w
Q>1
0>10
w
West ❑N/A OYes❑No 0 No Visible/Fine Layer ❑Yato 1w 0>10
Facade Description:
Roof
Debris: 910 Visible /Fine Layer .9 34 to 10 j]> 1w
Description:
Setbacks N/A j
Floor___ Debris: ❑ No Visible/Fine Layer ❑ l 4 to 1* 0>10
Floor____ Debris: No Visible/Fine Layer [] 3 to 1' 9> 1'
Floor____ Debris: No Visible/Fine Layer ❑ 34 to 1w ❑ > 1.
Floor____ Debris: No Visible/Fine Layer 34 to 1 0 > 1w
Floor. Debris: No Visible/Fine Layer E] % to 10 >
B 1w
Comments
Date: r~ 1200) o Inspection Team: Name: Div, 3 -e Agency:
Name: ccv Nki 1 Agency:
NYC WTC 000118649
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