WTC Visual Survey Form
•/
F emise Address:
13
Block: Residentia Commercial U Name of Building:
Lot: j Mix UseD Other
# of Stories: i f AKA's:
Building Owner?Management Telephone Number ( )
Name: FAX:
Address:
On Site Contact:
Name: ' ' .' Telephone Number.
Building Owner Management Activities
Interior Survey Performed Yes ❑ No
Exterior Survey Performed Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes 0 No Locations:
Air Monitoring j] Yes [] No Locations:
Copies of All Reports and Data Requested JJ Yes
Visual Inspection Results:
Facade:
Inspected Debris
North MN/A
South 0 N/A
es 0 No
es9No
o No Visible/Fine Layer
No Visible/Fine Layer H
%to I a
%to1"
0>1"
❑>1"
East /A esQNo No Visible/Fine Layer ❑%to1" 0>1"
West /A t es 0 No ❑ No Visible/Fine Layer E]%to1" 0>1"
Facade Description:
Setbacks N/A j]
Floor Debris: j] No Visible/Fine Layer ❑ 34 to 1" 0>1"
Floor. Debris: [] No Visible/Fine Layer ❑ h to 1" > 1"
Floor. Debris: a No Visible/Fine Layer ❑ 34 to 1" H;111"
Floor. Debris: No Visible/Fine Layer % to 1" ❑ > 1"
Floor Debris: No Visible/Fine Layer 34 to 1" ❑ > 1"
Comments
Dat& 12002 inspection Team: Name: C ~- Agency:
Name: Agency:
NYC-WTC 000125786
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000125786Source: NYC Law Department, mirrored locally