Q I Residential J J Commercia Naia of Buildin
Lot: Mix Use Other
# of Stores: uS, 1 AKA's: ,. , G
Building Owner anage nt: Telephone Number: ( )
Name: UO ~" FAX: )
Address:
On Site Contact:
Name: Telephone Number:
Building Owner Management Activities
Interior Survey Performed f 41es ❑ No
Exterior Survey Performed .[Yes ❑ No 1~+
General Clean Up des No ~_
Locations:_________________________________________
ACM Clean Up ❑ Yes No Locations:
Air Monitoring [ Sf o Locations:
Copies of All Reports and Data Requested p 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 ❑/2to 1" 0>1"
East 0 N/A fes ❑ No ❑ No Visible/Fine Layer ❑/ato1" 0>1"
West ❑ N/A es❑No ❑ No Visible/Fine Layer 0 1/2 to1" 0>1"
Facade Description:
Roof ~~
Debris: No Visible /Fine yer ❑ Y. to 1" -1 ❑ > 1" /
Descriptio
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer ❑ /s to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ /s to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date: / I A' /2002 Inspection Team: Name: L k1Z, -'.- " k" ("9 Agency: C'
Name: Agency:
NYC-WTC 000128346
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000128346Source: NYC Law Department, mirrored locally
Multi-page form documenting World Trade Center contamination assessment for a residential or commercial building, including facade inspection checklist and environmental testing…
3 shared non-person entities · Same agency, volume and box · similarity 0.976
WTC debris inspection form documenting visual inspection results for facade condition, ACM assessment, and building characteristics for a 3-story structure.