WTC Visual Survey Form iU0003 I
tI 3E address:
Ii 3EAVE! $7REET
Block: t Residential 0 Commercial Name of Building:
Lot: Mix Use 0 Other I P 7s
# of Stories: AKA's:
Building Owner/Management: Ljdite'X je ' ^ Telephone Number: (Z/Z) 49V - qa (a.
Name: 4 f FAX:
Address:
On Site Contact: r , 4 R"fcy
Name: Telephone Number: ( )
Building Owner Manágement Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up OYes ❑ No Locations:
ACM Clean Up ❑ Yes No Locations:
Air Monitoring ❑ Yes toNo Locations:
Copies of All Reports and Data Requested Yes
visual Inspection rwsuits;
Facade:
Inspected Debris
North ❑ N/A NYes ❑ No (No Visible/Fine-Laye€ _ ❑ % to 1" 0>1"
South
East
West
❑ N/A
N/A
N/A
0
Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
,No Visible/F4 ❑ % to 1"
❑ No Visible/Fine Layer ❑ % to 1"
❑ No Visible/Fine Layer E]'/ to 1"
❑ > 1"
❑ > 1"
0>1"
Facade Description:
Roof
Debris: No Visible {Fine-Layer ❑%to1" 0>1"
Description:
Setbacks N/A ('
Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'f2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Joint memorandum from NYC DEP and DOH advising building owners on post-9/11 maintenance, re-occupancy issues, and hazardous material assessments including asbestos.