NYC 9/11 Public Portal Document
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WTC Visual Survey Form
Premise Address: p 1 (~
' X
Block: Residential 0 tM Corinercial p I Name of•BuUdintw
Lot Mix Use 0 Other -
;tte of Stories: - AKA's: twv
Building Owner/Management Telephone Number ( )
Name: FAX:
Address:
On Site Contac
Name: ' ~- • Telephone Number
Building Owner Management Acthrlties
Interior Survey Performed 0 Yes 0 No
Exterior Survey Performed 0 Yes 0 No
General Clean Up 0 Yes 0 No .Locations:
ACM Clean Up ❑ Yes 0 No Locations:
Air Monitoring 0 Yes 0 No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North 0 N/A ❑ Yes 0 No ❑ No Visible/Fine Layer ❑ 34 to 1' ❑ > 1'
South N/A 0 Yes 0 No 0 No Visible/Fine Layer % to 1' 0>1'
East ENIA 0 Yes 0 No ❑ No Visible/Fine Layer 034t01' 0>1'
West 0 N/A O Yes 0 No 0 No Visible/Fine Layer 934t01' 9>1'
Facade Description: