WTC Visual Survey Form
Premise Address: I ~ ~
r
Block: ,3 Residential D Comm iaf Name of Building:
Lot: Mix Use Other
# of Stories: ~, AKA's: \„ v
Building Owner/Manage ent: , Telephone Number:; P11
Name: " Y `r" FAX:( )
Address:
On Site Conta : 0
Name: AAi \1 v,' '°' Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed J es ❑ No
Exterior Survey Performe es ❑ No
General Clean Up 21 es . No Locations:
ACM Clean Up ❑ Ye o 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 ❑'/2 to 1" ❑ > 1"
South . N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
East ❑ N/A -0Yes ❑ No ~'No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
West ❑ N/A JYes ❑ No Rj No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
Facade Description:
Roof
Debris: o Visible /Fine aver ❑ / to 1" •1 ❑ > 1"
Description:
Setbacks N/A
Floor: Debris: ❑ No Visible/Fine Layer 0 Y to 1" ❑ > 1"
Floor: iz-- Debris: [- to Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
A letter from the Department of Environmental Protection requesting copies of environmental hazard assessments and cleanup summaries for buildings near the World Trade Center site.
A letter from the Department of Environmental Protection requesting copies of environmental hazard assessments and cleanup summaries for buildings near the World Trade Center site.