Block: r Residential 0 Commercial 0 Name of Building:
Lot: 7 5 Mix Use - Other
# of Stories: c; 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 Yes
visual Inspection Results:
Facade:
Inspected Debris
Q °Yes ❑ No
North
South
East
❑ N/A
❑ N/A
Q`N/A
ayes ❑ No
❑ Yes Q No
' No Visible
No Visible
t r
❑ No Visible/Fine Layer
❑Ytol"
❑ % to 1"
❑%to1"
0>1"
0>1"
0>1"
West SN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
Facade Description:
I Roof
Debris: 0 No Visible -i._ ❑ Ya to 1" 0>1'
Description:
Setbacks N/APJ
Floor: Debris: ❑ No Visible/Fine Layer 0 % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to V ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
DEP inspection form for 50 Broadway documenting building characteristics, facade conditions, and asbestos-containing material survey across multiple building faces.