NYC 9/11 Public Portal Document
WTC Visual Survey Form K-& &Fore b(c
Premise Address:
Block: Residential LI CommercialZ Name of Building:
Lot: I Mix Use ❑ Other fl
# of Stories: .5 's:
Buildin Own . Management: Telephone Number: (L, -i- ) ?33 - s6 s S
Name: a le f FAX: ( )
Address: "1 -7 3 ;.~.. : - *,
On Site Contact:
Name: L," h ~/a - S •°~ - Telephone Number: (' , z ) 2 3)-c--i .
Building Owner Management Activities
Interior Survey Performed ❑ Yes [ I No
Exterior Survey Performed ❑ Yes [J No
General Clean Up Yes ❑ No Locations:
ACM Clean Up J Yes ❑ No Locations:
Air Monitoring ❑ Yes © No Locations:
Copies of All Reports and Data Requested ❑ Yes
Visual Inspection KeSuits:
Facade:
Inspected Debris
North R N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑/2to1" 0>1"
South N/A ❑ Yes ❑ No (]~ No Visible/Fine Layer ❑/2to1" 0>1"
East [ } N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yto1" 0>1"
West Q N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ /2 to 1" 0>1"
Facade Description:
Roof
Lt
" •I > 1"
Debris: No Visible /Fine ayer ❑ /2 to 1 : ❑ 1
Description:
Setbacks N/A
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"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Comments
Date: / //2002 Inspection Teat: Name: rfZ1 ,a 1r+t r Agency: (/.S E(-7
Name: /2.. ~ ,a,M ' Agency: ,v K c 1) E#
NYC-WTC 000122297
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