WTC Visual Survey Form Iaw IP'2
Premise Address:
/,4 CrzoL,D 57
Block: 7C Residential I Commercial El Name of Building:
Lot: 25 Mix Use 1 Other ?ht
# of Stories: AKA's: ---------------------------------------------------- -
Building Owner/Management: Telephone Number: PII
Name: FAX: P11
Address: Cwc-9 c7 .-.-. .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-..
On Site Contact:
Name: ' ' A ki 1cL, , 'sue- 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 ❑ Y2 to I"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to I"
West ❑ N/A EYes ❑ No Q No Visible/Fine Layer ❑'/2 to 1"
Facade Description:
Roof
Debris: J Ne lei -/Fine Layer ❑ % to l" O>1"
Description:
Setbacks NIAm
Floor. Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ V2 to 1" ❑ > I"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Comments
.mss
Date: Z / / S /2002 Inspection Team: Name: AZ >r-ah Agency: P.
Name: Agency:
si
NYC-WTC 000128134
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000128134Source: NYC Law Department, mirrored locally
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 275 Greenwich Street dated February 12, 2002.