* WTC Visual Survey Form
Premise Address:
/ s- i 4 -
Block: Residential 0 Commercialtj Fame of Building:
Lot: Mix Use J Other 0 - w •e s
# of Stories: dt AKA's:
Building Owner/Management: Telephone Number: ( )
Name: FAX:
Address:
On Site Contact:
Name: ' Telephone Number: )
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested U Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ® No ❑ No Visible/Fine Layer ❑ /a to 1" ❑ > 1"
South ❑ N/A ❑ Yes ® No ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
❑ N/A I J Yes No ❑ No Visible/Fine Layer ❑ > 1"
East
West ❑ N/A
Facade Description:
Yes ® No ❑ No Visible/Fine Layer D Va
'/ to 1"
to 1" ❑ > 1"
Roof
Debris: ❑ No Visible /Fine3La
W yer ®/ to 1"
.1 ;( 4
❑
> 1" 1 •L-4.
Description: (%bs i t d Gv rt. no,-
ft!S, A,- S S a /v%-e•/. n
Setbacks N/A [a
Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer ❑'/a to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ %a to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ / to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Cl S~'' S
Date: I ii' /2002 Inspection Team: Name: J Agency: 4c
Name: z Agency: MC O#i'
NYC-WTC 000123027
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NYC-WTC_000123027Source: NYC Law Department, mirrored locally