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WTC'Visiral Survey Form
Premise Address:, n 0r
Block: Residentt& -\ Commercial Name of Building:
Lot: Mix Use Other
# of Stories: AKA's:
Building r/Manage ent: Telephone Number: (2 i' y 2r — S` 3Gu
Name: OT4w%A0-0%1,, L L C_ FAX:
Address:
On Site Conta :
Name Telephone Number: ( )
Building Owner Management ctiv i s
Interior Survey Performed ❑"Yes J No
Exterior Survey Performed Yes ❑ No
General Clean Up ❑ Yes No Locations:
ACM Clean Up ❑Yes o Locations:
Air Monitoring des o Locations:
Copies of All Reports and Data RequestedJ Yes
Visual Inspection Results:
Facade:
pected
North ❑ N/A es❑No No Visible/Fine Layer '/2 to 1" ❑ > 1"
South ❑ N/A es ❑ No o Visible/Fine Layer '/2 to 1" ❑ > 1"
East ❑ N/A Yes ❑ No o Visible/Fine Layer '/2 to 1" ❑ > 1"
West ❑ N/A Yes ❑ No a -No Visible/Fine Layer '/2 to 1" ❑ > 1"
Facade Description:
IfQ
Roof
Debris: ❑ No Visible /Fine Layer to 1" 0>1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fi Layer 0'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine ryer ❑ %2 to 1" ❑ > 1"
Comments
Date 002 Inspection Team: Name: Agencyr'
Name: Agency:
NYC-WTC 000119247
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000119247Source: NYC Law Department, mirrored locally
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 141 Greenwich Street dated February 12, 2002.
Multi-page form documenting World Trade Center contamination assessment for a residential or commercial building, including facade inspection checklist and environmental testing…
WTC debris inspection form documenting visual inspection results for facade condition, ACM assessment, and building characteristics for a 3-story structure.