NYC 9/11 Public Portal Document
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WTC Visual Survey Form
Premise Address: . ;
}2- Uf Ceram ary D
Block: Residentiall | | Commercial [| Name of Building:
Lot: Mix Use[[] Other [7]
#of Stories: ¢ | AKA’s:
Building Owner/Management Telephone Number: ( )
Name: FAX: ( )
| Address:
On Site Contact:
"| Name: ° | 7 ‘Telephone Number: ( )
Building Owner Management Activities
Interior Survey Performed [[] Yes [_] No
Exterior Survey Performed [_] Yes (] No
General Clean Up []Yes[_]No _Locations:
ACM CleanUp []Yes[_]No Locations:
Air Monitoring []Yes[_]No Locations:
Copies of All Reports and Data Requested L_] Yes
Visual Inspection Results:
Facade:
inspected Debris
Facade Description: _ @
im PCL Tt te ST eer
North [JN/A LL] Yes [] No (INo Visible/Fine Layer []%to1” [> 1"
South [-{N/A Yes [_] No No Visible/Fine Layer []%to1” []>1"
East _] N/A L_] Yes (_] No [_]No Visible/Fine Layer []%to1” [> 1"
West L_JN/A (_] Yes [[] No [_]No Visible/Fine Layer []% to 1” L]> 1”
Roof
Debris: No Visible /Fine Layer _ 1% to 1” CJ> 1°
Description: Ine Prete EON jij."
Setbacks N/AL]
Floor: Debris: [[] No Visible/Fine Layer [_]% to 1” >1”
Floor: Debris: [_] No Visible/Fine Layer [_]% to 1” > 1”
Floor: Debris: [_] No Visible/Fine Layer [_]% to 1” > 1”
Floor: Debris: [_] No Visible/Fine Layer [_|% to 1° > 1°
Floor: Debris: [_] No Visible/Fine Layer [_]% to 1” [ ]> 1°
Comments
Date: ot _/ 26 /2002 Inspection Team: Name: pe Agency:
/ Name: Afni CK Agency:
NYC-WTC_000127418
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NYC-WTC_000127418Source: NYC Law Department, mirrored locally