NYC 9/11 Public Portal Document
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Premise A 9pss:
WTC Visual Survey Form (07 S9 g
D E d'1GtYl e Ptac'
Block: Residential Commercial El Name of Building:
Lot:I Mix Use ❑ Other
# of tories: AKA's:
Building Owner/ a agement: Telephone Number: )L3_ I23
Name: ;,,s~ . t FAX: ( )
Address:
On Site Contact:
Name: o — Telephone Number: (2I ) 5 -- (03S
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 Yes ❑ No o Visible/Fine Layer ❑ Ys to 1" ❑ > 1"
East ❑ N/A EYes ❑ No o Visible/Fine Layer ❑ 1/2 to I" ❑ > 1"
West ❑ N/A Yes ❑ No fl .No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Facade Description:
Roof
Debris: to 1" n> 1"
Description:
11t7(.
t7(.Jt )n —
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer [X]'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer E] '/Z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Comments
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Date: / (t /2002 Inspection by: Name: ';- rZ no { !1t i Cc T1 aencv: AJ (
NYC-WTC 000118712
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