WTC building inspection form, residential or commercial, Jun 2002

NYC 9/11 Public Portal Document

a WTC Visual Survey Form 100 I Z GS Premise Address:

Block g I g( A ti IeI Sr I Residential EJ Commercial 0 I Name of Building: Lot: 0 Mix Use U ther # of Stories: AKA's: fJ i Building er/Mana ement: Telephone Number: Name: r FAX: ) QIZ)7j Z•S'3 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 ❑%to1" 0>1" South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to 1" ❑> 1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to 1" 0>1" ❑ N/A ❑ Yes ❑ No West Facade Description: 91No Visible/Fine Layer ❑%to 1" 0>1"

Roof

Debris: ❑ No Visible /Fine Layer to 1" 0>1" Description:

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

Comments

Date: "J / /2002 Inspection by: Name: ~• L Agency: Name: Agency:

NYC-WTC 000127861