NYC 9/11 Public Portal Document
• WTC Visual S, vey Form
Premise Address:
Block: Residential 0 Comme cial Name of Building:
Lot: Mix Use Q Other
# of Stories: AKA's: ._._._._._._._._._._._._._._._._._._._._._._._._._._._.
Building Owpe / ana em t: Telephone Number P11
Name: ,. G \ ' c '— FAX. _._._._._._._._._._._._._._._._._._._._._._._._._._._._._._..
Address:
On Site Contact:
Name: Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed [ es ❑ No
Exterior Survey Performed [Yes ❑ No c f
General Clean Up- Yes ❑ No Locations:
ACM Clean Up Yes ❑ No Locations:
Air Monitoring [jYes ❑ No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected DeJ%ris
North ❑ N/A Yes ❑ No tjio Visible/Fine Layer ❑'/ to 1" ❑ > 1"
South ❑ N/A Yes ❑ No NNo Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
East ❑ N/A I,Yes ❑ No o Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Facade Description:
Roof
Debris: qNo Visible /Fine Layer ❑ 1/ 2 to 1" ❑ > 1"
Description:
Setbacks NSA
Floor: Debris: ❑ No Visible/Fine Layer % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > I"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
Comments
Date: Inspection Team: Name: Agency: Y `
Name: Agency:
NYC-WTC 000119366
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