l k: I Residential 0 Commercial J J Name of Building:
Lot: Mix Use Other
# of Stone : 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 inspecuan Results:
Facade:
Inspected Debris
North ❑N/A [ZYes❑No 12 No Visible r ❑'htol" 0>1"
South 0 N/A EYes ❑ No j$ No Visible/ L-e=uer ❑ % to l" 0>1"
East ERN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'%to l" 0>1"
West 'N/A D Yes (] No ❑ No Visible/Fine Layer ❑htol" 0>1"
Facade Description:
1
I Roof
Debris: J'No Visible r ❑'/tol" 0>1"
Description:
Setbacks N/A
Floor. Debris: ❑ No Visible/Fine Layer ❑'a to 1" 0>1"
Floor: Debris: 0 No Visible/Fine Layer 0 A to 1" 0> 1"
Floor: Debris: [] No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑'A to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'A to 1" ❑ > 1"
Comments
Date: /x/2002 inspection Team: Name: Agency: -D f'
Name: Agency: ------
ENTER E
NYC-WTC-000126185
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NYC-WTC_000126185Source: NYC Law Department, mirrored locally