NYC 9/11 Public Portal Document
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WTC Visual Survey Form 1000030
Premise Address:
BE Av c: . S„ r,t6 t
Block: 11 Residential fl Commercial Name of Building:
Lot: , "7 Mix Use ❑ Other ❑
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: FAX: ( )
Address:
On Site Contact:
Name: Telephone Number: ( )
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 Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El /2 to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
Facade Qescription:
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Roof
Debris: ❑ No Visible /Fine Layer Y2 to 1" ❑ > 1"
Description: FoM 1' Hr' a t 2c t , U(L( 1ti&--
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
Comments
(J a AcC-s
Date: / I i /2002 Inspection by: Name: t +~~~ ~kz,; r 1lLj- Agency: A)' CAcE
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, J. ,(e Name: Agency:
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NYC-WTC-000119212
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