NYC 9/11 Public Portal Document
WTC Visual Survey Form
.Premrse Address:
S' 7 Cr !► rt M r~ 5 -(.
Block: Residential 0 Commercial J Name of Building:
Lot: Mix Use I Other
# of Stories: AKA's:
Building Owner/Management: j-"' 113 iri ;>41y; Telephone Number: (l f L ) y 3 t ` 7 S-J
Name: /,,,; f l M ter, cork.- X/ -,'-J L L '< Y FAX: ('2 , Z. ) 27',..
Address: Lf 3~ Lt,1. /&i..- z
On Site Contact:
Name: ' /"J /i fJ /7 c ~~ ma c: r c '- Telephone Number: _ PII .,
Building Owner Management Activities
Interior Survey Performed []Yes E ) No
Exterior Survey Performed ❑ Yes (] No
General Clean Up Yes ❑ No Locations: -, yS
ACM Clean Up f] Yes 10 No Locations:
Air Monitoring ❑ Yes , ] No Locations:
Copies of All Reports and Data Requested D Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑x N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to l" ❑> 1-
South ❑ N/A Q Yes ❑ No ® No Visible/Fine Layer E]%Z to 1" 0>1"
East ©N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/to1" ❑>1"
West ® N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
Facade Description:
.e
Roof
YY
L~
Debris: Q~ No Visible /Fine yer Y. to 1"4 ~'~° ❑ > 1" 1
Description:
Setbacks N/A 4
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 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 ❑ Y2 to 1" ❑ > 1"
Comments
Date: I / /2002 Inspection Team: Name: r, 1r Agency: s/,4
Name: ~ A, 1, ci m- Agency: /✓'rc _) '
I 31
NYC-WTC 000122319
OCR can misread numbers and units. Confirm readings against the page image before using them.