WTC Visual Survey Form
Premise Addrea
If
Block: esidentia Commercial Name of Building:
Lot: Mix Use Other
# of Stories: AKA's:
Building Owner! n: Telephone Number: ( 24 Z) g~f Z i;
Name: ts~ v~^~ F
Address:
On Site Contact: ~M u
Name: - - f G' Te hon Number:
Building Owner Management Activities
Interior Survey Performed es ❑ No
Exterior Survey Pe orme Yes ❑ No .
General Clean Up es I3No Locations:
ACM Clean Up ❑ Yes j Vo Locations:
Air Monitoring No Locations:
r~ Copies of All Reports and Data Requested Yes
Visual Ii Results:
Facade:
Iç ~ected De ris
North ❑ N/A es [3 No [No Visible/Fine Layer ❑'/ to 1" ❑ >V
South ❑ N/A E Yes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1"
East ❑ N/A es ❑ No No Visible/Fine Layer ❑ % to V [3 >1'
West ❑ N/A tyesE]No No Visible/Fine Layer ❑ % to 1" 0>1"
Facade Description:
Roof
Debris: o ne /Fine ltyer I '0% to i 11
Description: c e \ VPW
Setbacks N/A ❑
Floor: -No Visible/Fine Layer ❑'/ to 1"
Debris 0>1"
Floor: Debris: ❑ o Visible/Fine Layer ❑ % to 1" 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y: to 1" ❑ > I"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" (, > ''
Floor: Debris: ❑ No Visible/Fine Layer 0
Y to 1"
Comments
u t
Date: / /2002 Inspection Team: Name:
fl
Name:
NYC-WTC 000119204
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000119204Source: NYC Law Department, mirrored locally