NYC 9/11 Public Portal Document
r WTC Visual Survey Form
Premise Add ss:
Block: I Reside ti I D Commerciç1 Name of Building:
Lot: Mix Use't Other
# of Stories: AKA's:
Building wner/Managerpent:
— // 7Tii1/L/ P/ace
,
/
57-c'1 kcDaAcP-/
Telephone N tuber: (2 c L) 1 ~,~
Name: t pJ 'Ni FAX: ( )
Address: 1_,w- C'"1
On Site Contact: ti
Name: ' J)11 W t -d Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed Yes ❑ No
Exterior Survey Performed Yes ❑ No
General Clean Up ❑ Yes jj No Locations: V\
ACM Clean Up ❑ Yes o Locations:
Air Monitoring es ❑ No Locations: J\M
Copies of All Reports and Data Requested es
Visual Inspection Results:
Facade:
Inspected De is
North ❑ N/A es ❑ No o Visible/Fine Layer ❑ /z to 1" ❑ > 1"
South ❑ N/A es ❑ No No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
East ❑ N/A J Yes ❑ No Jallo Visible/Fine Layer ❑ /z to 1" ❑ > 1"
West ❑ NIA 7J Yes ❑ No [No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Facade Description: ,,,.
Roof
Debris: Visible /Fine ye ❑/zto
Description:
Setbacks N/A,
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to I"
Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ /s to 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ /s to 1"
Comments
06,
Date: I / /2002 Inspection Team: Name: ~ -'^'rc i i'"1c-v~;yr Agency:. f l_
Name: Agency:
J
I?
NYC-WTC 000122464
OCR can misread numbers and units. Confirm readings against the page image before using them.