NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address: G i ,~
( iii htS
Block: Residential 0 Commercial Na a of Building
Lot: Mix UseD Other ,1 1 / e .' S f
# of Stories: AKA's:
Building Ow{ier/Management: Telephone Number, (d ~) ~~ _ cc
Name: ' E ' i -!+ FAX:
Address:
On Site Contacts ~f
Name: ar~r c 1riC s Telephone Number (lit) ? cs 7
Building Owner Management Activities
Interior Survey Performed ❑ Yes No
Exterior Survey Performed Yes ( No
General Clean Up Yes 0 No Locations: /I
I I f / . s w~'Tr ~' /,1/,
*~~^_¢ i
ACM Clean Up 0 Yes No Locations: r t ot. # . .,w. L. rs.4
Air Monitoring ❑ Yes No Locations:
Copies of All Reports and Data Requested fl Yes
Inspected Debris
North NIA Yes 0 No D No Visible/Fine Layer 0'%S to 1" 0>1"
South ❑ NIA HYesoNo R No Visible/Fine Layer ©% to 1" ❑ > 1"
East Q N/A Q Yes 0 No Q No Visible/Fine Layer 0% to 1" 0>1"
West ©N/A O Yes D No _] No Visible/Fine Layer 0 % to 1" 0>1"
Facade Description: 'tr• tee.
1" s—..
Roof
Debris: ❑ No Visible /Fine yer jZ to 1" •1 ="i '"'4 0> 1" 1
Description: r t< l - :.(-.., ; a .,,.. y4 e . . .,- .. . (u-'.
Setbacks NIA D'
Floor. Debris: 0 No Visible/Fine Layer Q % to 1" 0>1"
Floor: Debris: ['j No Visible/Fine Layer 0 4 to 1" 0> 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ % to 1" 0> 1"
Debris: © No Visible/Fine Layer 0% to 1"
Floor:
Floor: Debris: 0 No Visible/Fine Layer to 1"0% 0> 1"
> 1"
Comments
Name: /c ,' r,.¶,.. Agency: /.• -*( ') wF
1. ` FIB-' Y' ^ r^•t S +~,c
r +•'~.v y J
1
NYC-WTC 000122167
OCR can misread numbers and units. Confirm readings against the page image before using them.