WTC Visual Survey Form ) 1'
Premise Address: 15 3
OEM 6
Block: Residential Commercial Name of Building:
Lot: Mix Use fl Other
# of Stories: j. AKA's:
Building Owner/Management ~(0 n -e. Telephone Number: ( )
Name: FAX:
Address:
On Site Contact: wZ 3
Name: ' u' Tell hone Number:
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes No
General Clean Up Yes No Locations:
ACM Clean Up g Yes No Locations:
Air Monitoring []Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North /A Yes ❑ No No Visible/Fine Layer r4 to 1" 0>1"
South RN/A [] Yes ❑ No o Visible/Fine Layer ❑%to1' 0>1"
0 Yes ❑ No
q
East ❑ N/A O No Visible/Fine Layer /:to1" ❑ >1"
West ❑N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑Yato1" 0>1"
Facade Description:
Roof _
Debris: No Visible /Fine Layer .❑ i4 to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor. _„__ Debris: ❑ No Visible/Fine Layer 934 to 1" 0>1"
Floor. Debris: 0 No Visible/Fine Layer 0h to 1" ❑ > 1"
Floor: __ Debris: 0 No Visible/Fine Layer 0 % to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer y4 to 1" ❑ > 1"
Floor____ Debris: ❑ No Visible/Fine Layer g '4 to 1" ❑ > 1"
Comments
/A' -
Date: Inspection Team: Name: Agency:
Name: Agency:
EkT E
NYC-WTC 000127117
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NYC-WTC_000127117Source: NYC Law Department, mirrored locally
Department of Environmental Protection inspection form for WTC-area building documenting facade condition, asbestos, and other environmental hazard assessments.
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 275 Greenwich Street dated February 12, 2002.