WTC Visual Survey Form ~'~ `I C€ ,
Premise Address:
16 ~ t3rowa~iv~
Block: , „ Residential 0 Commercial Name of Building:
Lot: 75O Mix Use 0 Other ,(; 'p P j *$
# of Stories: g+/ AKA's:
Building OwnertManagement: Telephone Number: (Le L, ) t 7- 7716
Name: /3iwK(e try a r FAX: (
Address: /~evnr
On Site Contact:
Name: , ,i lI* - P 1a Telephone Number: (z' Z.) y,7 _
Building Owner Management Activities
Interior Survey Performed Yes ❑ No
Exterior Survey Performed J[ Yes ❑ No
General Clean Up ® Yes ❑ No Locations:
ACM Clean Up ® Yes ❑ No Locations:_ Aw~soe~ t
Air Monitoring (4 Yes ❑ No Locations:
Copies of All:Reports and Data Requested Yes
visual inspection Results:
Facade:
Inspected Debris
North ❑ N/A Yes ❑ No Q No Visible/Fine Layer ❑ %a to 1" 0>1"
> 1"
South ❑ N/A 1 Yes ❑ No No Visible/Fine Layer ❑ Ya to 1" > 1"
East ❑ N/A ® Yes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1"
West ❑ N/A Yes ❑ No [~J No Visible/Fine Layer 0114t01" 0>1"
Facade Description:
Roof
Debris: ® No Visible /Fine ayer ❑'/Z to 1" 1 ❑ > 1" '/
Description:
Setbacks NIA Z,
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0
V to 1" ❑ > 1"
r , ^Mman"
Date: _j_/ Z. S /2002 Inspection Team: Name: . f *4v cK Agency: t9 10t4
Name: l • d alb Agency: Ngc D E )O
NYC-WTC 000124222
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000124222Source: NYC Law Department, mirrored locally