g1N. 100106
WTC Visual Survey Form
Premise Address:
16 r t'S~o.~olrv.o-t
Block: Residential 0 Commercial E Name of Building:
Lot: 5O f Mix Use Other .( >= A
141-A
# of Stories: AKA's:
Building Owner/Management: Telephone Number: (Li ti,) ?7- 714
Name: u(4 t ta! rat FAX:
Address: SAirt
On Site Contact:
Name: • - S 3.eu rrti lrt -P (dc Telephone Number: (2,'._) y r . s;
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:____________________________________
t
Air Monitoring Yes ❑ No Locations:
Copies of All;Reports and Data Requested J J Yes
Visual inspection Results:
Facade:
Inspected Debris
North ❑ N/A ® Yes ❑ No Q No Visible/Fine Layer ❑%tol" 0>1"
South ❑ N/A (z Yes ❑ No ® No Visible/Fine Layer ❑Y2to1" 0>1"
East ❑ N/A ® Yes ❑ No No Visible/Fine Layer ❑Y2to1" 0>1"
West ❑ N/A R Yes ❑ No [J No Visible/Fine Layer ❑ 2 to 1" 0>1"
Facade Description:
tCv 4t
Roof
Debris: ® No Visible /Fine yer ❑ Y2 to 1" .4 — 0>1"
Description:
Setbacks N/A
Floor:
A Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer ❑Y2 to 1" ❑ > 1"
Floor. Debris: ❑ No ViSible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ %a to 1" ❑ > 1"
Date: /_/2 5 /2002 Inspection Team: Name: 9, ft ftae4'1ctt Agency: t9 i °t4.
Name: - O !(e (It Agency: C
J
NYC-WTC 000124227
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NYC-WTC_000124227Source: NYC Law Department, mirrored locally