Block: Residential CommerciaI Name of Building:
Lot: r Mix Use J Other
# of Stories: AKA's:
Building Owna1Management: Telephone Number: ( )
Name: FAX:
Address:
On Site Contact:
Name: * Telephone Number:
Building Owner Mana ement 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 Debris
North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to1" 0>1"
South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" 0>1"
East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to1" 0>1"
West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to 1" 0>1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑'/to1"^
Description:
Setbacks N/A ❑
Floor: Debris: [] No Visible/Fine Layer ❑ 6 to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑V:to 1" ❑ > 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ > 1"
Floor:
Floor:
Debris: ❑ No Visible/Fine Layer O V to 1"
% to 1"
Debris: ❑ No Visible/Fine Layer ❑ Va to 1"
❑ > 1"
❑ > 1"
Comments
Date: C) I_"! /2OO2 Inspection Team: Name: (.// '1 ` mil,__. Agency:
Name: Agency:
N T E RE
NYC-WTC 000128484
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000128484Source: NYC Law Department, mirrored locally
A Department of Environmental Protection form recording facade and ACM inspection results for a building at 141 Greenwich Street dated February 12, 2002.