Block: Residentia Commercia Name of Building:
Lot: Mix Use 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 ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested D Yes
Visual Inspection Results:
Facade:
Inpected De rls
North ❑ N/A No No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
South ❑ N/A ❑Yes❑No No Visible/Fine Layer ❑ 2 to 1" 0>1'
East ❑ N/A ❑Yes❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0> 1"
West ❑ N/A . o Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Facade Description: