Asbestos inspection report form for unspecified premises

NYC 9/11 Public Portal Document

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WTC Visual Survey Form Premise Address: L i1.'t~n h- ; S frr ./ Block: Residential D Commercial 0 Name of Building: Lot: Mix Use Other I cE # of Stories: S AKA's: Building Owner/Man Bement: Telephone Number: (2, z ) fi =r 3 - Name: t I) C FAX:( Address: -, / -' 1 On Site Contact: Name: C r-FA."• j.q r ,. c, - Telephone Number: (2'L) , 3 Y'? Building Owner Management Activities Interior Survey Performed ❑ Yes [D No Exterior Survey Performed ❑ Yes [J No T General Clean Up Q Yes ❑ No Locations: : ~: . : - ACM Clean Up ❑ Yes Q No Locations: Air Monitoring ❑ Yes[] No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" South ❑ NIA D Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" East N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" West [] N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/: to 1" ❑ > 1" Facade Description:

Roof ` }~ u t. Debris: ❑ No Visible /Fine Layer Q V to 1" •1 ~'' ❑> 1" ;I Description: c; ;, 4, ie /i k ,` ( /i'1' t y F

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1 ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/% to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: I i /2002 Inspection Team: Name: K / Z , + f r, Agency: L Name: r:, ' „- ~. Agency: I) . t-'

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NYC-WTC 000122257