Block: Residential DCommerdal Name of ui din.
Lot: Mix Use . Other, ..
-~
# of Stories: AKA's:
Building Owner/Management: Telephone Number- ( )
Name: FAX:
Address:
On Site Co tact:
Name: Telephone Number. t
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 Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer /z to 1" 0>1"
South ❑ N/A ❑ Yes ❑•No []No Visible/Fine Layer % to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer % to 1" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Y2 to 1" 0>1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer —j$.'/s to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer 0 Y to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ 4 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"
Comments