NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
Block: , Residential Commercial Name of Building:
Lot: Mix Use ❑ Other El
# of Stories: E` AKA's:
Building Ownerl Management: Telephone Number: (' ) ,ts~
Name: / f;t ic. , - C FAX: ( )
Address 1, a° . . ~.
On Site Contact: '
Name: / /E / E .. - ~ Pte^ Telephone Number:; P11
Building Owner Management Activities `.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes No
General Clean Up j Yes ❑ No Locations:
ACM Clean Up ❑ Yes No Locations:
Air Monitoring El Yes ]No Locations:
Copies of All Reports and Data Requested ❑ Yes
visual inspection Results:
Facade:
Inspected Debris
North N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ to 1"
'/2 ❑ > 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer [J to 1"
1/2 ❑ > 1"
East Q N/A j] Yes ❑ No ® No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West Q N/A ❑ Yes ❑ No '[] No Visible/Fine Layer ❑ 1,4 to 1" ❑ > I"
Facade Description:
Roof
Debris: No Visible /Fine ayer El
1/2 to 1" ? ;t ❑ > 1" 1
Description:
Setbacks N/A 0
Floor: Debris: ❑ No Visible/Fine Layer ❑'/z 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 El 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Comments
Date: / /2002 Inspection Team: Name: F +Z,- 4-,' r Agency: (.YS é
62
Name ( ji -,~. p. Agency: C ?a"f
3
NYC-WTC 000122273
OCR can misread numbers and units. Confirm readings against the page image before using them.