NYC 9/11 Public Portal Document
WTC Visual Survey Form i r7Q -~? U —T
FE.'ti r;Address: ,
- o ek,n &g E' /3l 3
Block: qt4 Residential Commercial j J Name of Building:
Lot: Mix Use 0 Other
# of Stories: AKA's:
Building Owner/Management: Sc tt Telephone Number: (2i 2.) zb-r - 61go
Name: ¶ a ,Lo. FAX:
Address:
On Site Contact:
Name: 'e c Kk . Sa Telephone Number:
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ( Yes ❑ No Locations: vow,b%A
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring EYes ❑ No Locations: vawt' s
Copies of All Reports and Data Reguested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A 'Yes ❑ No No Visible/Fine Layer ❑%tol" 0>1"
South ❑ N/A CRYes ❑ No No Visible/Fine-may&r ❑'%to l" 0>1"
East ❑ N/A 0 Yes ❑ No ® No VisibleEFirtlstayer ❑%to1' 0>1"
West ❑ N/A 'Yes ❑ No j No Visible/Fine-Layer ❑ % to l" 0>1"
Facade Description:
Roof
Debris: 2 No Visible /Fine-I eyes ❑'/ to 1" ❑ > 1"
Description:
Setbacks N/A
Floor. Debris: ❑ No Visible/Fine Layer ❑ va to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑'%a to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'% to V ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑'h to V ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑% to 1" ❑ > 1"