NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
-fl {f: fc .:; -1
Block: cj Residential D Commercial j Name of Building:
Lot: Mix Use Other
,
# of Stories: AKA's:
Building Owner/Management: Telephone Number: (z, ) r ;3 s
Name 4 ,- ::.1 ec i P_ rry FAX ( )
Address: _ i>,.>.t,F-/"' i ri,
On Site Contact:
Name: (i ft-x h i 3 A - 5~ r Telephone Number: (z/ z )
Building Owner Management Activities
Interior Survey Performed ❑ Yes ® No
Exterior Survey Performed ❑ Yes R] No
General Clean Up J Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes (] No Locations:
Copies of All Reports and Data Requested D Yes
Visual Inspection Results:
Facade:
Inspected Debris
North © N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
South ❑ N/A [E Yes ❑ No E] No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
East Q N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ !2 to 1" ❑ > 1"
West ] N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Facade Description:
Roof
Debris: j No Visible /Fine Layer ❑ 1/2 to 1" {'~'' ❑ > 1" 1
Description:
Setbacks N/AJ
Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
Floor: Debris: E] No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Comments
Date: 1 /i'7' /2002 Inspection Team: Name: i'Z 1_' /- c t Agency: Va £/'
Name: e-ti .er- Agency: ,tJ' : ,3J1
33
NYC-WTC 000122277
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