WTC Visual Survey Form
Premise A ss:
Em .'X cha. n e P' ac e
Block: Residential Commercial U Name of Building:
Lot: Mix Use EJ Other
# of tories: AKA's:
Building Owner/ aagement: Telephone Number: )135. 1n`3
Name: FAX: ( )
Address:
On Site Contact:
Name: A03 - Telephone Number: ( ) (C3S
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 o Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1"
South ❑ N/A 7Yes ❑ No o Visible/Fine Layer III 1/2 to 1" ❑ > 1"
East ❑ N/A Yes ❑ No o Visible/Fine Layer ❑'/z to 1" ❑ > 1"
West ❑ N/A Yes ❑ No fl No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Facade Description:
Roof
Debris: No Visible /Fi to 1" n> 1"
Description:
1rrc~E 1n m-.
Setbacks N/A ❑
Floor: Q Debris: ❑ No Visible/Fine Layer Q % to 1" ❑ > 1"
Floor: L Debris: ❑ No Visible/Fine Layer ½ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 9½ to 1" ❑ > 1"
Comments
Date: / 162 /2002 Inspection by: Name: rin Tt p t gency: EP
Name: Agency:
NYC-WTC- 000118702
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NYC-WTC_000118702Source: NYC Law Department, mirrored locally