WTC building inspection form, residential or commercial, Jun 2002

NYC 9/11 Public Portal Document

a WTC Visual Survey Form t d d 1z ~o c Premise Address:

Block: g I g(, A w,4 Sr I Residential 0 Commercial 0 I Name of Building: Lot: Q Mix Use U ther # of S ories: AKA's: Building er/Mana ement Telephone Number: Z) Name: r FAX: ) z %c3 Address: On Site Con ct: Name: Telephone Number. ) Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested J Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to 1" O>1" South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑Veto 1" O>1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer 014101" O>1" West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to 1" O>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer to 1" O>1" Description:

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer ❑ 16 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"

Comments

Date: ~S / /2002 Inspection by: Name: C• L Agency: Name: Agency:

NYC-WTC 000127861