WTC building inspection form, mixed-use, 8 pages

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: Ij — yI C -a_ s j (Z "r

Block: Residential Commercial J Name of Building: Lot: Mix UseD ther9_________ S 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 D YesD No Exterior Survey Performed 0 YesD No General Clean Up YesD No Locations: ACM Clean Up YesD No Locations: Air Monitoring Yes No r]

Locations: Copies of All Reports and Data Requested Yes Visual lnsaection Results: Facade: Inspected Debris North ❑ N/A tJYesDNo D No Visible/Fine Layer 0 % to 1' 9>1' South ll/A esD No o Visible/Fine Layer D34 to 1' 0>1' East 5'N/A Yes Q No o Visible/Fine Layer % to l' >i' West [j N/A YesDNo El No Visible/Fine Layer £13410 1' D> I' Facade Description: n o

Roof Debris: D No Visible /Fine Layer I-]% to 1" 1J> 1' Description: C €

Setbacks N/At Floor. Debris: No Visible/Fine 3% to 1' £1> 1' Floor.____ Debris: No Visible/Fine Layer 34 to 1' >1' Floor____ Debris: No Visible/Fine Layer LayerP%tolo >1' Floor Debris: No Visible/Fine Layer 34101' >1' Floor Debris: No Visible/Fine Layer 34 to 1' > 1' Comments

Date: Inspection Team: Name: Agency: Name: Agency: ENT'ERE

NYC-WTC 000127228