WTC Visual Survey Form to 0 1Z 6
Premise Address:
I0 Fu Ron5+ree-+
Bloc : Residential ~"' Commercial 0 Name of Building:
Lot: Mix Use El Other
# of S es: AKA's:
Building Owner/Management Telephone Number. ( )
Name: FAX:
Address:
On Site Contact:
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 Yes
Visual Inspection Results:
Facade:
Inspected
North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑Ytol" 0>1"
South ❑N/A ❑Yes❑No No Visible/Fine Layer ❑%tol" 0>1"
East ❑N/A ❑Yes❑No No Visible/Fine Layer ❑ Y to l" 0>1"
West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%tol" 0>1"
Facade Description:
Debris: ❑ No Visible /Fine Layer )% to 1" 0>1"
Description:
Setbacks N/A ❑
Floor Debris: ❑ No Visible/Fine Layer ❑'/to l" 0>1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer 0 % to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer ❑ Y to l" 0>1"
Comments
I
Date: Q / 17 /2002 Inspection by: Name: AP Agency: Dt P
Name: Agency:
NYC-WTC 000127954
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000127954Source: NYC Law Department, mirrored locally