Block: Residential Commerci& N m►e of ildi g: n
Lot: Mix Use 0 Other s t- C .
# of Stories: AKA's: 9 91
Building OwnerThkanagement Telephone Number. ( )
Name: FAX:
Address:
On Site Contact
Name: • * Telephone Number:
Building Owner Management Activities
Interior Survey Performed ❑ Yes [] No
Exterior Survey Performed D Yes D No
General Clean Up Yes D No Locations:
ACM Clean Up Yes D No Locations:
Air Monitoring ❑ Yes 0 No Locations:
Copies of All Reports and Data Requested p Yes
Visual Inspection Results:
Facade:
Inspected Debris
North D N/A DYesDN0 ❑ No Visible/Fine Layer *: to l" 0>1"
South D N/A Yes D No O No Visible/Fine Layer %tot" >1"
East j] N/A Yes [] No No Visible/Fine Layer '/:tor" >1"
West ❑ N/A Yesj]No No Visible/Fine Layer n to 1" 0>1"
Facade Description:
.
Roof ~„ o i• w~
trJ r
.P/~ P
Debris: o Visible/Fine Layev D Wto V V S
Description. S < --"'
Setbacks N/A D
Floor. Debris: j] No Visible/Fine Layer 0 % to 1" 0> 1"
Floor. Debris: D No Visible/Fine Layer 0 % to 1" ❑ > 1"
Floor. Debris: D No Visible/Fine Layer h to 1" ❑ > 1"
Debris:DNo Visible/Fine Layer
Floor:
Floor. Debris: D No Visible/Fine Layer
% to 1"
H301
> 1"
0