Block:`I4 Residential 0 Commercial J Name of Building:
Lot: Q 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 0 Yes Q No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up 0 Yes 0 No Locations:
ACM Clean Up Yes [j No Locations:
Air Monitoring [] Yes Q No Locations:
Copies of All Reports and Data Requested Yes
visuals inspection KesuIts:
Facade:
Inspected
North 0 N/A Yes Q No No Visible1t b O14to1' 0>1*
South E N/A 8Yes0No O No Visible/Fine Layer 0'/:to 1' D>1
East j `N/A 0 Yes Q No O No Visible/Fine Layer DY2tol* 0>1*
West (3N/A 0Yes0No O No Visible/Fine Layer j]/ato1" 0>1'
Facade Description:
Roof
Debris: E"No Visible IF `ta i' ❑ Ya to 1' 0>1*
Description:
Setbacks N/A 0
Floor, ___
Floor
Debris: Q No Visible/Fine Layer ❑ 14 to 1'
Debris: ❑ No Visible/Fine Layer ❑ 14 to 1
0> 1'
0> 1'
Floor: Debris: 0 No Visible/Fine Layer ❑ y4 to 1' 0> 1'
Floor Debris: No Visible/Fine Layer [] 4 to 1' 0> 1'
Floor. Debris: 0 No Visible/Fine Layer 014 to 1* ❑ > 1'
Comments
Date: ~ Inspection Team: Name: 44- 4 4a4LArJ Agency: V1.
E NT ERE O Name: Agency:
NYC-WTC 000126150
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NYC-WTC_000126150Source: NYC Law Department, mirrored locally