WTC facade inspection form for residential building, June 2002

NYC 9/11 Public Portal Document

IV 1'fV'f"L WTC Visual Survey Form Premi d ss: y T Block Residential ~ Commercial Name of Building: Lot: 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 qebris North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer 0'/2 to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'/2 to 1" [1> 1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'/2 to 1" 0>1" West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof

Debris: []No Visible /Fine Layer %2 to 1" ❑ > 1" Description:

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 ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments

Date: j2Qj2002 Inspection by: Name: [ L. Agency: Name: Agency:

NYC-WTC-000119565