Block: Residential0 Commercial J Name of Building:
Lot: Mix UseD Other
# of Stories: AKA's:
Building Ow er/Managem nt: Telephone Number: ( )
Name: 14j . C.~ - --_ FAX:
Address:
On Site Contact:
Name: ' ' .. . Telephone Number.
Building Owner Management Activities
Interior Survey Performed Yes No
Exterior Survey Performed 0 Yes g No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up [)Yes ❑ No Locations:
Air Monitoring O Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
Visual inspection Results:
Facade:
Inspected Debris
North
South
East
❑N/A
❑ N/A
❑ N/A
BYesoNo
Yes❑No
❑ Yes ❑ No
❑ No Visible/Fine Layer
❑ No Visible/Fine Layer ❑34to1w
❑ No Visible/Fine Layer
1 w
'/ato1"
❑
❑
"
>1w
0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer '/:to1" 0>1"
Facade Description: AA
Roof
Debris: JNo Visible /Fine Layer D 4 to 1" ❑ > 1"
Description:
Setbacks N/Ac's``
`..
Floor. Debris: ❑ No Visible/Fine Layer ❑ 34 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer 0y4 to V 0>1'
Floor Debris: ❑ No Visible/Fine Layer 34 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer 934 to V ❑ >V
Comments
C% 1 j
Date: L I fi.I2OO2 Inspection Team: Name: . Agency:
Name: Agency:
NYC-WTC 000126364
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000126364Source: NYC Law Department, mirrored locally
Department of Environmental Protection inspection form for WTC-area building documenting facade condition, asbestos, and other environmental hazard assessments.