WTC Visual Survey Form ! O 7 9 oo I
Prarnise Address:
Bloclç 0 Residential 0 Commercial Name of Building:
Lot: Mix Use 0 Other
# of S ones: AKA's•
Building Owner/Management Telephone Number: ( )
Name: l/ ~C~--~` FAX:
Address:
On Site Contact
Name: * * Telephone Number.
Building Owner Management Activities
Interior Survey Performed ❑ Yes [j No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up 0 Yes 0 No Locations:
ACM Clean Up ❑ Yes 0 No Locations:
Air Monitoring ❑ Yes 0 No Locations:
Copies of All Reports and Data Requested Yes
Visual Insaection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %to 1" 0>1"
South ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer /atol w ❑ >1"
East ❑ N/A D Yes ❑ No ❑ No Visible/Fine Layer ❑ Ya to l" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑vatol" 0>1"
Facade Description: „ /1
Roof
Debris: NVisibleIFineLayer ❑ 1A to 1" 0>1"
Description:
Setbacks N/A`
Floor. Debris. ❑ No Visrble/rme Layer ❑ Ya to 1w ❑ > 1w
Floor Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer % to 1" ❑ > 1"
Floor. Debris: 0 No Visible/Fine Layer 034 to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer 0'/ to 1" ❑ > 1"
Comments
Date: I I1 12002 Inspection Team: Name: Agency:
Name: Agency:
ENTERED
NYC-WTC 000126359
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000126359Source: NYC Law Department, mirrored locally
Department of Environmental Protection inspection form for WTC-area building documenting facade condition, asbestos, and other environmental hazard assessments.
DEP inspection form recording building details and facade conditions (north, south, east, west sides) with damage extent measurements and ACM documentation.
Department of Environmental Protection inspection form for WTC-area building documenting facade condition, asbestos, and other environmental hazard assessments.