NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address: ~-
Block: t Residential Commercial Name of Building:
Lot: Mix Use Q Other El
# of Stories: E` i AKA's:
Building Owner/Management: Telephone Number: (z, 4 ) -
Name: fl f;ti , - C FAX: ( )
Address: "l a 4. ~- r
On Site Contact:
Name: / lE / F ..7, - P ^ Telephone Number: (2 z )
Building Owner Management Activities
Interior Survey Performed ❑ Yes [ No
Exterior Survey Performed ❑ Yes No
General Clean Up Yes Q No Locations:
ACM Clean Up ❑ Yes No Locations:
Air Monitoring Q Yes ENo Locations:
Copies of All Reports and Data Requested ❑ Yes
visual Inspection Kesuits:
Facade:
Inspected Debris
North [ ]N/A Q Yes ❑ No Q No Visible/Fine Layer Q'/2 to 1" 0>1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Q'/2 to 1" ❑ > 1"
East Q N/A % Yes Q No No Visible/Fine Layer Q'/2 to 1" ❑> 1"
West Q N/A ❑ Yes ❑ No '[] No Visible/Fine Layer ❑l2 to 1" ❑> 1"
Facade Description:
Roof ~`st
Debris: Q No Visible /Fine Layer ❑'/2 to 1" ~9 ;1 ❑ > 1" 1
Description:
Setbacks N/A [
Floor: Debris: Q 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"
Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"
Floor: Debris: [] No Visible/Fine Layer Q'/2 to 1" ❑ > 1"
Comments
Date: I I , /2002 Inspection Team: Name: F +'Z-, 4-,' Agency: (J t 64
Name: f- I ,gym -, p, Agency: / '- C t?a=f
3 -
NYC-WTC 000122273
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