WTC building inspection form, mixed-use, 8 pages

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: _ l \ c4 - Block: Residential Commercial 9 Name of Building: Lot: Mix Use9 OtherD S of Stories: AKA's: l g-%'-- Building Owner/Management: Telephone Number. ( ) Name: FAX: Address: On Site Contact Name: ' " Telephone Number. Building Owner Management Activities Interior Survey Performed 9 Yes No Exterior Survey Performed 9 Yes No General Clean Up Yes No Locations: ACM Clean Up Yes No Locations: Air Monitoring L] Yes 9 No Locations: Copies of All Reports and Data Requested Yes Visual inspection Results: Facade: Inspected Debris North 0 N/A ❑ Yes D No D No Visible/Fine Layer 1:J36 to l' D>1'. South ❑ N/A DYesDNo ❑ No Visible/Fine Layer 36 to 1 ' 0 >1 ' East 9 N/A 9 YesD No O No Visible/Fine Layer '%to1 ' 8 30 11'

West D N/A ❑ Yes j]t~o O No Visible/Fine Layer 9%to1' 9>1' Facade Description: / U

Roof

Debris: D No Visible /Fine Layer =J 34 to 1' ' - D > 1' Description:

Setbacks wPç ' Floor. Debris:DNo Visible/Fine Layer 34 to 1' 9>1' Floor.____ Debris: No Visible/Fine Layer 34 to 1' 0>1' Floor.__ Debris: No Visible/Fine Layer 34to 1' >1' Floor.____ Debris: No Visible/Fine Layer 34 to 1' > 1' Floor. Debris: D No Visible/Fine Layer 34 to 1' >1' Comments

Date: Cj i 12002 Inspection Team: Name: Agency: , Name: Agency: ATE

NYC-WTC 000127230