WTC Visual Survey Form
Premise Address: i
L 1
13
U
Residential U Commercial IJ Name of
Block:
Lot: Mix Use D Other
# of Stories: < AKA's:
Building owner/Management Telephone F
FAX:
Name:
Telephone Number.
Name:
uiicling owner manaeanoal" ..,w..No-
Interior Survey Performed 0 Yes 0 No
Exterior Survey Performed 0 Yes 0 No
General Clean Up 0 Yes [] No Locations:
ACM Clean Up ❑ Yes 0 No Locations:
Air Monitoring 0 Yes 0 No Locations:
CoDses of All Reports and Data Requested 0 Yes
Visual It Results:
Facade•
Inspected Debris
0 No Visible/Fine Layer ❑'/ to 1" [J>1"
North ❑ N/A 0 Yes 0 No 0> 1"
South 0 N/A EJ Yes 0 No 0 No Visible/Fine Layer ❑'/ to 1"
0>1"
East 0 N/A ❑ Yes 0 No ❑ No Visible/Fine Layer ❑ % to 1"
❑ Yes 0 No 0 No Visible/Fine Layer ❑'/2 to 1" 0> 1"
West 0 N/A
Facade Description:
Roof
['/2 to 1" 0>1"
Debris: 0 No Visible /Fine Layer . ..
s?Cti C C i,y 6r
Description:
Setbacks N/A 0
Debris: 0 No Visible/Fine Layer ❑'h to 1" 0> 1"
Floor:
Debris: 0 No Visible/Fine Layer ❑'A to 1" ❑ > 1"
Floor:
Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor:
Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: ❑ >1
Floor: Debris: 0 No Visible/Fine Layer 0% to 1"
Comments
Date: l /.._J2002 Inspection Team: Name: At Agency:
Agency:
Name: l i i;~ 2 t L c.
NYC-WTC 000126986
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000126986Source: NYC Law Department, mirrored locally
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 141 Greenwich Street dated February 12, 2002.