WTC Visual Survey Form
Premise A doss:
b 15F-' ( 1an e PCa.c
Block: f Residential 0 Commercial ❑ Name of Building:
Lot: Mix Use ❑ Other ❑
# of tories: AKA's:
Building Owner/ a agement: Telephone Number: ) 35 I ~3
Name: s~ l< E FAX:( )
Address:
On Site Contact:
Name: Telephone Number: (o2Ja) S- (O3S"
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 ❑'/z to 1" ❑ > 1"
South ❑ N/A 7Yes ❑ No No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
East ❑ N/A es ❑ No o Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West ❑ N/A tyesE] No ¶JNo Visible/Fine Layer ❑ Y2 to 1" [1> 1"
Facade Description:
Roof
Debris: No Visible to 1"
Description: fl
,s ' - -.. .~