Block: Residential Commercial Name of Building:
Lot: Mix Use Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: FAX: (
Address:
On Site o ct•G _` --~
Name: ~v Io J L Telephone Number: ("7 '
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ 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 ❑'/z to 1" ❑ > 1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0 '/2 to 1" ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ / to 1" ❑ > 1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑ % to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"
Floor. Debris: 0 No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1"
Comments M
t3 L&QL •
Date: f/ ~ 002 Inspection Team: Name: . `FL " —Agency:
Name: - H 4.b ,► Agency: i S
NYC-WTC 000126922
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NYC-WTC_000126922Source: NYC Law Department, mirrored locally