NYC 9/11 Public Portal Document
WTC Visual Survav Form 1001(D O(,
Premise Address:
L31 PLAIe ç $1
Block• f4j7 ResidentialD Commercial LI Name of Building:
Lot: Mix Use D Other0
v
M
# of tories: AKA's:
Building Owner/Management% sf .1y i.Lc . Telephone Number. (2/z.) 6 2—i _ —
Name: 1c 4u SI, s,,+ 2 FAX:
Address: / am
On Site Contact
Name: Telephone Number. )
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes 0 No Locations:
Copies of All Reports and Data Requested 0 Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ®'Yes ❑ No No Visible ❑'/ to 1" ❑>1"
South ❑ N/A JYes ❑ No 0 No Visible "' 0½t0 1" 0>1"
East E N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'/ to 1" 0>1"
West [ZN/A ❑Yes❑No ❑ No Visible/Fine Layer ❑ !z to 1" ❑>1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer l$'/z to 1" ❑ > 1"
Description: Rea r pov&1y « - -"o - ii r
c •ya'Zti
Setbacks N/AN
Floor: Debris: ❑ No Visible/Fine Layer 0½ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer ❑'f to 1" ❑ > 1"
Comments
Date: II /2002 Inspection by: Name: Ra , Agency: <DCP
ENT ERE Name: Agency:
NYC-WTC 000126177
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