Block: ResidentialD Commercial p of Building:
Name
Lot: Mix Use fl Other ❑
# of Stories: AKA's: 7 VJc L r✓ I
Building Owner/Management
Telephone Number. ( )
Name: FAX: )
Address:
On Site Contact:
Name: 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:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer '/to1" 0>1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer '/2 to 1" 0>1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer '/2to1" 0>1"
West ❑ N/A ❑ Yes [] No ❑ No Visible/Fine Layer '/tol" 0>1"
Facade Description: