NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
Block: f..~ Residential 0 Commercial D Name of Building:
Lot: ¢- Mix Use Other ►v`1C DOS "DOS.
# of Stories: 12 AKA's:
Building Owner/Management: D o S Telephone Number: (7 i,) 33 _ q 1 Q
Name: rn, ~- c r~~ FAX:(
Address:
On Site Contact: t4y M`I7t
Name: Lcs 4- Telephone Number: (212-) ' 37w
Building Owner Management Activities
Interior Survey Performed ❑ Yes 0 No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up Yes ❑ No Locations: r4 C r L. Lj. - sr is t .. _ c,
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 N le/Fine Layer n'/2 to 1" ❑ > 1"
South ❑ N/A Yes ❑ No f J Ne-Vi3ibIe/Fine Layer ❑'/:to1" 0>1"
East ❑ N/A DYes ❑ No ❑ No Visible/Fine Layer ❑'/2to1" ❑>1"
West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" D>1"
Facade Description:
Roof
Debris: /Fine Layer ❑'/ to 1" ❑ > 1"
Description: Ov- 1 vzcvt- des
LoJ - t" z (e t< -v / - -<'f-. - zcrt cL,.c..,cL.
Setbacks N/A c
Floor. \ Debris: ❑ No Visible/Fine Layer ❑'/ 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 ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date: 3 / 2_ /2002 Inspection Team: Name: ____ '✓ , Agency: /'-f C 96P
Name: Agency:
NYC-WTC-000118928
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