WTC Visual Survev Form InAI 17 19
Pre.l e Address:
~
:i
Block: Residential U Commercial J Name of Building:
Lot: Mix Use 0 Other
# of Stories: AKA's:
Building Owner/Management: 27 cum sr R t p Telephone Number. (212) -
Name: Raj s h FAX:
Address: 27 C t- F,c sr i /p,
On Site Contact:
Name: - .r • 1 Telephone Number:
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up Yes D No Locations:
ACM Clean Up 0 Yes No Locations:
Air Monitoring ❑ Yes No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
South l N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
East ❑ N/A Yes ❑ No [ No Visible/Fine Layer ❑ Y2 to 1'" 0>1"
West J N/A ❑ Yes ❑ No [] No Visible/Fine Layer El%a to 1" 0>1"
Facade Description:
Roof
Debris: ~ % to 1" ❑ > 1"
Description:
Setbacks N/A EJ
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Comments