NYC 9/11 Public Portal Document
•.,~ / 3 WTC Visual Survey Form
Premi?eAd : o.'w,t
Block Residential 0 Comer ' Na a of Building:
Lot: Mix UseD Other D "Li vee-c
# of S or es: 6 AKA's:
Building Owner/Management: Telephone Number. (141. ) a,z.'y.. ~o~Z
Name: FAX:
Address:
On Site Contac
Name: " ' . 4-Sow I{v l(A evr,1 ?l r. Telephone Number.(?4t) Z•
Building Owner Management Activities
Interior Survey Performed Q Yes Q No
Exterior Survey Performed Q Yes Q No
• General Clean Up jI Yes Q No Locations: . co.
ACM Clean Up Q YesJ No Locations:
Air Monitoring [ Yes D No Locations:
Copies of All Reports and Data Requested Q Yes
Visual inspection Results:
facade:
• Inspected Debris
North t] N/A ® Yes Q No ❑ No Visible/Fine Layer % to 1"
" -'South Q N/A ® Yes Q No ❑ No Visible/Fine Layer J to 1"
'h
East Q N/A Yes Q No ❑ No Visible/Fine Layer % to 1"
West Q N/A fJ Yes ❑ No ❑ No Visible/Fine Layer [j % to 1"
Facade Description:
Roof pjst
to
Debris: QNo Visible /Fine yer Va to 1" •J =i""' ❑ > 1" 1
Description: oa /'d# , , ds s~' .i1 bv. d, t.
Setbacks N/A ❑
Floor 4 Debris: Q No Visible/Fine Layer % to 1" ❑ > 1"
Floor Debris: Q No Visible/Fine Layer [] % to 1" 0> 1"
Floor. Debris: Q No Visible/Fine Layer 034 to 1" ❑ > 1"
Floor. Debris: Q No Visible/Fine Layer D6 to 1" ❑ > 1"
Floor Debris: Q No Visible/Fine Layer 034 to 1" 0> 1"
Date: 1 /.2r,2002 Inspection Team: Name: R Agency: 1 • 01
I Name: . Ol ,P!/ 0 Agency: NBC DE /o
NYC-WTC 000122818
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