WTC Visual Survey Form SW 1001026
Premise Address: t o
Block: 41" Residential D Commercial Name of Building:
Lot: ISp Mix Use Other
# of Stories: AKA's:
Building Ovyner/Management: Telephone Number: ( )
Name: 1~1 FAX:
Address: l -o i 0Cr
On Site Contact:
Name: • tV\L Telephone Number:
Building Owner Management Activities
Interior Survey Performed EVes ❑ No
Exterior Survey Performed [` es ❑ No
General Clean Up EYes ❑ No Locations:
ACM Clean Up ❑ Yes No Locations:
Air Monitoring 1s ❑ No Locations:
Copies of All Reports and Data Requested rYes
Visual Inspection Results:
Facade:
Inspected bris
North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%tol" 0>1"
South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑Y2to 1" 0>1"
East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to 1" 0>1"
West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to1" 0>1"
Facade Description:
Roof ,)5t,
~ L~
Debris: ,N o Visible /Fine tayer ❑ V to 1" •1 ~~""`~ ❑ > 1" '
Description:
Setbacks N/A'J
Floor: Debris: 0 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"
WTC debris inspection form documenting visual inspection results for facade condition, ACM assessment, and building characteristics for a 3-story structure.