NYC 9/11 Public Portal Document
r`
~---- ; WTC Visual Survey Form
Premise Address:
Block: Residential 0 Commercial Name of Building:
Lot Mix Use fJ Other
# of Stories: AKA's:
Building Owner/Management: . Telephone Number. ( )
Name:A'i c ~aE`~ i r' FAX:
Address:
On Site Contact: S u -pEr
Name: N I j-_ S s.f L A ,Y Telephone Number: (2 /L- ) 'fó - if, C
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up Yes No Locations: ►N :, n E K .n; ~c ( -y c f zn)
ACM Clean Up LI JYes No Locations:
Air Monitoring J 'Yes ❑ No Locations: ; . ' ,ms: ur i_ c A r c~-
-+ /wrt~ AI l ,hc •-h: Copies of All Reports and Data Requested Yes
visual inspection Keswts:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ to 1"
'/2 ❑ > 1"
South N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
East I N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
West N/A []Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑'/2 to 1" ❑ > 1"
Description: v, s. t .i& D "&-Ic II L .~, fl (:1ry -"'T
Setbacks N/A [f
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 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 ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Comments
Date: / G /2002 Inspection Team: Name: R • F' h r'c: t -i cry Agency: V / r'l1
Name: ti * Mtr, Agency: IVj . is-n
RF kA
NYC-WTC 000126255
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