NYC 9/11 Public Portal Document
WTC Visual Survey Form 1o5tIk~U~?
b remise Address:
9p 6 FED SrREE T áJ # 7
Block: gLf Residential CommercialEJ Name of Building:
Lot: I Mix Use D Other
# of Stories: AKA's:
Building Owner/Management: S m Telephone Number. (2i z) 2 &I-1 - &qa
Name: j or Lo . FAX:
Address:
On Site Contact
Name: "A 'e, cu Kk . Telephone Number:
Building Owner Mana ement Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up EYes ❑ No Locations: va.'i
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring f R Yes L] No Locations: van-Pays
Copies of All Reports and Data Re uested Yes
visual inspection Kesuits:
Facade:
Inspected Debris
North ❑ N/A 'Yes ❑ No J No Visible/Fine Layer ❑ 1/ to 1" 0>1"
South ❑ N/A EYes ❑ No 2 No Vsible/Finoe ~r ❑'h to 1" 0>1"
East ❑ N/A 0 Yes ❑ No ® No Visible/Firte-tàyer ❑'/ to? [3>1"
West ❑ N/A f Yes ❑ No ® No Visible/Finc Layer ❑ 1/2 to 1" 0>1"
Facade Description:
Roof
Debris: No Visible /Fine-Sayer ❑to1" []>1"
Description:
Setbacks N/A
Floor. Debris: ❑ No ViSible/Fine Layer ❑'%2 to 1' ❑ > 1'
Floor. Debris: ❑ No Visible/Fine Layer 0 % to 1' ❑ > 1"
Floor Debris: ❑ No Visible/Fine Layer [31/2 to 1' ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑'!to 1" ❑ > 1"
Floor Debris: 0 No Visible/Fine Layer 034 to 1" 0> 1"
Comments