NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
f C/?Lt', I JY
Block: / Residential Commercial Name of Building:
Lot: Mix Uses Other ❑
# of Stories: AKA's:
Building Owner/Management:/,2a Paek i-Y Telephone Number: (71S )2z - 217
Name: /Ylr'kr 7, 'Nc f xnc ~t FAX: ( )
Address:
On Site.Contact:.-._.-._.-.-.-.-.-._.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-..._ .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-. -
Name: ; PII Telephone Number:; P11 ..
Building Owner ,Management Activities --.-.-.-. .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-....
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up Q Yes ❑ No Locations: SM j g i 11 c-
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
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Facade:
Inspected Debris
North ❑ N/A Q'Yes ❑ No No Visible/Fine Layer ❑'/z to 1"
South ❑ N/A ❑ Yes ❑ No O No Visible/Fine Layer ❑ 1/z to 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1"
Facade Description:
Roof
Debris: +1k /Fine Layer ❑'/z to 1" l > 1"
Description: 1.11.e ~ 6~,s ties ,-v l w ' ~-t4,i t:~ t2rr me y
i. _ )1 dd /tea_ r_.l&- c.
Setbacks N/A P
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" [2 >1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" [2 >1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" [2 >1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/Z to 1" [2 >1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" [2 >1"
Comments
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Date: (2/ / 21,- /2002 Inspection Team: Name: R , r i ai Agency: US SPA
Name: R Agency: 1C$Ef.
NYC-WTC 000122156
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