NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
Block i 9 1 Residential LI Comr~erpia Name of Building:
Lot: ,7 w i;; Mix Use D Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number. ( )
Name: FAX:
Address:
On Site Contact:
Name: ' Telephone Number:
Building Owner Management Activities
Interior Survey Performed D Yes D No
Exterior Survey Performed D Yes D No
General Clean Up D Yes D No Locations:
ACM Clean Up D Yes D No Locations:
Air Monitoring D Yes D No Locations:
Copies of All Reports and Data Requested D Yes
Visual Insaection Results:
Facade:
Inspected Debris
North j (/A ❑ Yes D No D No Visible/Fine Layer DYato l" 0 >1"
South D N/A es 0 N 2No Visible/Fine Layer ❑%tol" 0>1"
East j ,N/A 0 Yes 0 No O No Visible/Fine Layer /Z to l " 0 >1"
West j3,N/A D Yes [] No D No Visible/Fine Layer D%sto 1 " 0 >1"
Facade Description:
Roof
Debris: j No Visible /Fine Layer .D % to 1" D > 1"
Description:
Setbacks N/AD
Floor. Debris:D No Visible/Fine Layer ❑ y4 to 1" ❑ > 1"
Floor. Debris: D No Visible/Fine Layer 0 1/2 to 1" 0> 1"
Floor: Debris: D No Visible/Fine Layer 0 % to V 0> 1"
Floor Debris: D No Visible/Fine Layer ❑% to 1" 0> 1"
Floor. Debris: D No Visible/Fine Layer ❑ % to 1" 0> 1"
Comments
Date: / 1 12002 inspection Team: Name: Agency:
_. Name: Agency:
NTE
NYC-WTC 000126129
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