NYC 9/11 Public Portal Document
i
' - "`--WTC Visual Survey Form / I
Premise Address:
5,
Block: esident" , ommerciai Name of Building:
Lot: Mix Use Other
# of Stories: AKA's: _
Building Owne */M g'ment: 7 Telephone Number II
Name: FAX:
Address:
On Site Contact: f
Name: V '` t/" \ - Telephone Number: ( )
Building Owner Management ctivities
Interior Survey Performed Ye ❑ No
Exterior Survey Performed~es ❑ No
General Clean Up Yes Locations: -o'f W
ACM Clean Up 'Yes No Locations:
Air Monitoring Yes ❑ No Locations:
Copies of All Reports and Data Requested J Yes
Visual Inspection Results:
Facade:
I pected D brie
North ❑ N/A jZ1YesDNo No Visible/Fine Layer ❑ '/2to I"
South ❑ N/A es ❑ No No Visible/Fine Layer ❑'/2 to 1"
East Q N/A Yes❑No ' 'No Visible/Fine Layer ❑ % to 1"
West ❑ N/A -Yes ❑ No o Visible/Fine Layer ❑ '/2 to 1"
Facade Description:
Roof
Debris: o Visible /Fine Layer ❑'/2 to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: Debris: Q No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0
V to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ !2 to 1" ❑ > 1"