NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
sv' (3.,0i4 ,,4
Block: Residential Commercial Name of Building:
Lot: Mix Use EJ Other
# of Stories: 3 AKA's:
Building Owner/Management: Telephone Number: (Zr. ) Gig - to 6 F
Name: 4 , 7r. f A e^ I t FAX:
Address: So € €4
On Site Contact:
Name: vh u f Cc' fl lc4 h. Telephone Number: (Z - ) ((1- ,cc
Building Owner Managemerft Activi ies
Interior Survey Performed ® Yes ❑ No
Exterior Survey Performed ] Yes ❑ No .
General Clean Up ® Yes ❑ No Locations: Co L c,- .e r ,
ACM Clean Up ❑ Yes ❑ No Locations: f AAR,,1 of h•vj ,-
Air Monitoring © Yes ❑ No Locations: G
Copies of All Reports and Data Requested ❑ Yes
Visual Inspection Results:
Facade:
Inspected De
North ❑ N/A 3Yes0No ® i ' Fine Layer E]'/2 to 1" 0>1"
South ❑ N/A J Yes ❑ No e/Fine Layer ❑ 1/2 to 1" 0>1"
East ❑ N/A Yes ❑ No isi ine Layer ❑Y2 to 1" 0>1"
West ❑ N/A [KYes ❑ No o bl ine Layer ❑'/2to1" 0>1"
Facade Description:
Roof
Debris: o Visible ine ayer 0'/2 to 1" ? ~'' ❑ > 1"
Description:
Setbacks N/A ❑
Floor: Debris: t No Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: 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"
Comments
Date: 2 Y/2002 Inspection Team: Name: / ' _i9 h d #P14'c 2 t Agency:
Name: Agency:
NYC-WTC 000123362
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