NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address: e ~
Z
Block: Residential 0 Commercial Name of Building:
Lot: Mix Use Other
#of Stories: AKA's:
Building wner/Man gement: Telephone Number: ( )
Name: OCb A atY~ = 1'' FAX:
Address:
On Site Contac • '
Name: N e`~o ~8 ~% J.1~ Telephone Number: (2 t gelI 6
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 -es ❑ No ,~ No Visible/Fine Layer ❑ '/2 to 1" ❑> 1
South ❑ N/A Yes ❑ No o Visible/Fine Layer ❑'/ to 1" ❑ > 1"
East ❑ N/A A Yes ❑ No o Visible/Fine Layer 0'/2 to 1" ❑ > 1"
West ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Facade Description:
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Roof
Debris: ' 'No Visible /Fine Layer ❑ % to 1" ` ❑ > 1"
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0 % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > I"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Comments 4 t, `' (0 ~.~
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Date: / /2002 Inspection Team: Name: L SIi Agency: !
Name: Agency:
NYC-WTC- 000119014
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