NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Addre
Block: esidentia Commercial D Name of Building:
Lot: Mix Use J Other
# of Stories: AKA's:
Building Owner/ ge en : l Telephone Number: ( `1 a ) ~ Z 1~-~
F
Address: (ti - '
On Site Contact: ` , a
Name: Y UI \ U' Tefephonè Number: ( )
Building Owner Management s4CtiViti S '
I
Interior Survey Performed Yes ❑ No
Exterior Survey Pedorme Yes ❑
General Clean Up, esnTlo Locations:
ACM Clean Up [J Yes o Locations: J
Air Monitoring No Locations:
f~ Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
If1 ected Debris
North ❑ N/A Yes ❑ No N`No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
South ❑ N/A E Yes ❑ No QNo Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
East ❑ N/A f Yes ❑ No J No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Facade Description:
Roof
Debris:
Description:
o Vi ible /Fine Layer ' ❑ Y2 to
1
0>1"
Setbacks N/A ❑
Floor: l___ Debri No Visible/Fine Layer ❑'/ to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" 0>1"
Floor: Debris: [] No Visible/Fine Layer ❑ % to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
Comments
1 - CC,, ~^' i w
//
C.. {
Date: I / " /2002 Inspection Team: Name: Agency:
Name: Agency:
NYC-WTC-000119203
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