WTC Visual Survey Form /07QgoA
r ,
lock: -Residential C mmercial Name of Building:
Lot: Mix Use Other
# of Stories: 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 Q Yes [] No
General Clean Up 0 Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring (] Yes ❑ No Locations:
Copies of All Reports and Data Requested p Yes
Visual Inspection Results:
Facade:
Inspected Debris
North 0 N/A ❑YesQNo O No Visible/Fine Layer E]% to 1' 0>1'
South
East
West
❑ N/A
❑ N/A
❑ N/A
❑YesQNo
OYesDNo
YesQNo
❑ No Visible/Fine Layer D%to1 :
❑ No Visible/Fine Layer ]~ 2 to 1'
❑ No Visible/Fine Layer %to1'
0>1
0 >1'
0>1
'
'
Facade Description:
Roof
Debris: No Visible /Fine Layer 0 % to 1' [J> 1'
Description:
Setbacks N/A
Floor. Debris: 0 No Visible/Fine Layer ❑ 36 to 1'
Floor Debris: ❑ No Visible/Fine Layer [] % to 1'
Floor. Debris: ❑ No Visible/Fine Layer ❑ 3h to 1'
Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1'
Floor. Debris: ❑ No Visible/Fine Layer 36 to 1'
Checklist form documenting building characteristics, facade visual inspection results, and asbestos presence assessment at 196 Broadway for post-9/11 environmental evaluation.